Open repair of extent-III thoracoabdominal aortic aneurysm using a modified branch-first technique

Hybrid repair of type II thoracoabdominal aortic aneurysm using modified branch-first technique

“…The procedure was performed without cardiopulmonary bypass. 2 In the present case, we have combined this technique with a hybrid repair to treat a type II TAAA. The patient provided written informed consent for the report of his case details and imaging studies.…”

Advantages of combined distal‐first and visceral branch‐first technique: A universal fit for extensive thoracoabdominal aortic aneurysm?

“…Estrera et al reported the “distal first approach” assumes the advantage of providing a distal fenestration and ensuring adequate antegrade blood flow at an early stage for patients with chronic aortic dissection 5 . Previous reports have described the utility of “visceral branch‐first techniques” in reducing visceral ischemic time with minimal reperfusion injury 6,7 . Marchenko et al also successfully devised a novel “iliac branch first” strategy combined with the distal‐first approach for Crawford extent II TAAA using a “neo‐graft.” 8 A bifurcated graft of the neo‐graft was anastomosed to the common iliac arteries first, followed by reattachments of the left renal artery, superior mesenteric artery, and celiac axis without aortic cross‐clamp.…”

Commentary: Modified branch-first technique in thoracoabdominal aortic aneurysm repair: Does simpler mean safer?

“…The genuine intention of thoracoabdominal aortic aneurysm (TAAA) repair is the restoration of a regular anatomy with a special attention to limit a potential end-organ ischemia to a minimum during repair. 1 This journey began with a simple clamp-and-sew technique and developed later into very sophisticated approaches that include repair under left heart bypass or full cardiopulmonary bypass with mild, moderate, or deep hypothermia; distal exsanguination; and additional intermediate and combined strategies applying selective organ perfusion not only to visceral, renal, and the lower extremities arteries but also to the spinal cord. 2 , 3 Not to mention that extracorporeal circulation represented the basis for the majority of these operative techniques.…”