Abdominal aortic aneurysm repairDownloads

A 70-year-old man presents for his annual check-up. He says he feels well except for occasional abdominal pain. He describes the pain as 4/10–5/10 in intensity, diffusely localized to the periumbilical and epigastric regions, radiating to the groin. The pain occurs 1–2 times a month and always subsides on its own. The patient denies any recent history of fever, chills, nausea, vomiting, change in body weight, or change in bowel and/or bladder habits. His past medical history is significant for hypertension, hyperlipidemia, and peripheral vascular disease, managed with lisinopril and simvastatin. The patient reports a 40-pack-year smoking history and 1–2 alcoholic drinks a day. The blood pressure is 150/100 mm Hg and the pulse is 80/min. Peripheral pulses are 2+ bilaterally in all extremities. Abdominal exam reveals a bruit in the epigastric region along with mild tenderness to palpation with no rebound or guarding. There is also a pulsatile abdominal mass felt on deep palpation at the junction of the periumbilical and the suprapubic regions. The remainder of the physical exam is normal. Laboratory studies show: Serum total cholesterol 175 mg/dL Serum total bilirubin 1 mg/dL Serum amylase 25 U/L Serum alanine aminotransferase (ALT) 20 U/L Serum aspartate aminotransferase (AST) 16 U/L Which of the following is the most likely diagnosis in this patient?

During a surgical procedure to repair an abdominal aortic aneurysm, the surgeon must be careful to avoid injury to which of the following arterial structures that originates near the level of the renal vessels?