Aortic Hybrid Sutureless Anastomosis on Porcelain Aorta

Bonvini, Stefano; Zavatta, Marco; Grego, Franco; Piazza, Michele

doi:10.1177/1526602815575260

Cited by 3 publications

(7 citation statements)

References 7 publications

(7 reference statements)

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“…In 2008, Lachat et al 12 introduced the Viabahn Open Revascularization TEChnique (VORTEC), in which a stent graft is used to form a sutureless anastomosis in renal revascularization surgery. Since then, several authors (Bonvini et al, 13 Segers et al, 14,15 Donas et al, 16 Papadimitriou et al 17 ) have attempted to use this technique in aortic surgery. According to this technique, the aorta is punctured and a guidewire is positioned in the aorta.…”

Section: Aad Typesmentioning

confidence: 99%

“…A total of 41 studies 10,11,13,14,[16][17][18][19] were identified that reported outcomes for the use of AADs during surgery for thoracic and abdominal aortic reconstruction (Supplementary Tables I and II, online only). The meta-analysis included 27 studies with 50 cohorts, incorporating 1260 patients (Supplementary Table I, online only).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Also, 30 animal studies were identified that were subsequently excluded. Fourteen studies 13,14,16,18,21,25,35,[37][38][39][42][43][44]51 with a population of fewer than three patients were excluded. The corresponding sample sizes ranged from 4 to 101 individuals, and the follow-up period ranged from 12 to 204 months.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…devices during open surgery, whereas five studies [13][14][15][16][17] reported a laparoscopic approach. Only two studies 34,45 reported comparative results of postoperative outcomes for hand-sewn anastomosis vs AADs.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 99%

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Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Manolesou

Papaioannou

Georgiopoulos

et al. 2019

Journal of Vascular Surgery

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Objective: One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device.Methods: An electronic search was performed using MEDLINE, Scopus, ScienceDirect, and Cochrane Library by two independent authors. Our exclusion criteria included studies incorporating fewer than three patients and studies reporting results solely from animals or in vitro testing, results solely from end-to-side anastomosis, and results solely from endarterectomy procedures. The last search date was February 1, 2018.Results: A total of 41 studies were identified that reported outcomes for the use of three different device types: IRG, anastomotic stenting technique, and surgical staplers. The last two types were classified together as the non-IRG group. The meta-analysis included 27 studies with 50 cohorts incorporating 1260 patients. The median age of the incorporated patients was 61.4 years (range, 51-73 years), and 68.9% were male. The operations were performed for the treatment of acute aortic dissection in 82.3%. The pooled overall 30-day mortality rate varied by device type; IRG devices had a mean rate of all-cause mortality of 9.71%, whereas non-IRG devices were associated with a significantly (I 2 ¼ 15.78%; P for Cochrane Q test < .19) lower rate of death (1.47%). The pooled mean aortic cross-clamping time was 35.83 minutes. Metaregression showed that the performance of two-sided anastomosis with the IRG device significantly decreased the aortic cross-clamping time. However, a successful two-sided ringed anastomosis was performed in approximately half of the cases.Conclusions: Taking into account that the majority of operations were performed for the treatment of acute aortic dissection, AADs had a relatively low rate of 30-day mortality. Despite the observed heterogeneity in study protocols and the small sample size in the non-IRG group, the non-IRG group presented with the lowest 30-day mortality rate. Specific device-related complications between the different device types need further investigation.

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Section: Aad Typesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Section: Journal Of Vascular Surgerymentioning

confidence: 99%

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Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Manolesou

Papaioannou

Georgiopoulos

et al. 2019

Journal of Vascular Surgery

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“…Sutureless anastomoses with covered self-expanding stents such as the VORTEC (Viabahn Open Revascularisation TEChnique) have been described for several anatomic areas with technical success [3,4,5]. The Gore hybrid vascular graft (GHVG), to our knowledge currently the only available device with these features, represents the natural evolution of these techniques.…”

Section: Commentmentioning

confidence: 99%

Clampless and Sutureless Hybrid Technique for Aortic Arch Debranching on a Porcelain Aorta

Poletto

Musto

Civilini

et al. 2016

The Annals of Thoracic Surgery

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An innovative hybrid approach to the supraaortic vessels in a porcelain aorta and severe fibrotic tissue reaction at the neck is described. The technique is demonstrated in an 80-year-old woman with previous several carotid operations but still experiencing recurrent transient ischemic attacks. Clinical success was achieved at midterm follow-up, demonstrating the efficacy of hybrid treatment for this high-risk patient. Novel prosthetic vascular grafts that can be applied without cross-clamping may also provide a solution to approaching a porcelain aorta and difficult anatomies.

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Hybrid Clampless Anastomosis in Antegrade Aorto-Superior Mesenteric Artery Bypass

Tanda,

Zappadu,

De Donno

et al. 2023

Vasc Endovascular Surg

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Background Bypass surgery in severe aorto-iliac calcifications is a complex procedure. Aortic clamping can be highly risky and endovascular approach can be unsuccessful. We report our experience describing three cases of chronic mesenteric ischemia. In all three cases the preoperative computed tomography angiography revealed an ostial occlusion of the celiac trunk and of the superior mesenteric artery (SMA), a coral reef abdominal aorta, and severe calcification of the iliac arteries. An antegrade aorto-mesenteric bypass using a hybrid clampless anastomosis on the supraceliac aorta was performed. Results The procedures were performed via laparotomy. We carried out the exposure of the anterior supraceliac aorta limited to the zone without major calcifications; then we performed a side-to-end media-adventitial anastomosis between the supraceliac aorta and a Dacron graft 7 mm without any arteriotomy or clamping. The proximal graft and the aortic anastomosis site were punctured using a 18 G needle. An introducer was then positioned over a wire through the prosthetic graft and pushed into the aorta. Balloon expandable covered stenting to open and stabilize the anastomosis site was performed. Finally, the graft was tunneled to the SMA, and an end-to-side anastomosis was performed. The postoperative courses were uneventful, and the patients were promptly discharged. The follow-up, which in the first case is 4 years, showed the complete patency of the graft in each of the cases treated. Conclusions The hybrid clampless anastomosis appears to be safe and useful in cases of severe aortic calcification.

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Aortic Hybrid Sutureless Anastomosis on Porcelain Aorta

Abstract: This sutureless anastomosis technique seems safe and feasible and represents a valid alternative to standard surgical approaches in cases of heavy and circumferentially calcified infrarenal aorta.

Cited by 3 publications

References 7 publications

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Clampless and Sutureless Hybrid Technique for Aortic Arch Debranching on a Porcelain Aorta

Hybrid Clampless Anastomosis in Antegrade Aorto-Superior Mesenteric Artery Bypass

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