Single stem visceral debranching for complex aortic disease

Abstract

What this paper adds Treatment of complex aortic diseases including thoracoabdominal aortic aneurysms and aortic dissection is highly challenging. Hybrid repair may be useful in some situations wherein anatomy, the need of emergent repair or patient comorbidities preclude the use of total endovascular or direct open reconstruction. This paper details an original hybrid repair in which a single branch is used to reroute all visceral vessels. Abstract: Objective: Hybrid treatment of complex aortic disease has been described with various techniques of retrograde visceral bypass. The use of a single branch to revascularize all renal and visceral vessels may be less cumbersome than multiple synthetic branches and may seems to be efficient in terms of patency. Methods: We retrospectively included 15 patients between 2013 and 2021. Indication was aortic dissection (AD) (type A, acute or chronic type B), thoracoabdominal aortic aneurysms (TAA), visceral occlusive disease. Surgery consisted in median laparotomy, visceral vessel debranching from native aorta or from an aortic graft. In case of AD, surgical fenestration was performed. Additional TEVAR completed the treatment when indicated, during the same procedure or later on Results: Mean age was 60 years. 9 (60%) patients were treated for AD, 3 (20%) for TAA, 3 (20%) for occlusive disease. A total of 65 target vessels were debranched through the single stem retrograde vascular graft (SSRVG) technique. Aortic surgical fenestrations were performed in 8 cases and TEVAR in 4 cases. In the postoperative course, 3 TAA patients died,7 patients developed renal insufficiency (47%), 4 patients presented pneumonia (27%) and 3 colonic ischemia (20%). After a mean follow up of 21 months, all vessels (but 2 IMAs) were patent and no endoleak was noted. Conclusion: SSRVG technique offers a feasible and safe solution in various complex aortic diseases. The use of a single graft makes the technique straightforward by reducing the volume of multiple branch assembly in the retroperitoneal space with satisfying patency rates. Further studies with larger patient sample size and longer follow up are needed to elucidated the efficacy and durability of the technique.