Davaine JM, Jayet J, Oiknine L, Martin G, Couture T, Verscheure D, Koskas F. Single Stem Visceral Debranching for Complex Aortic Disease.
EJVES Vasc Forum 2022;
55:16-22. [PMID:
35299720 PMCID:
PMC8920873 DOI:
10.1016/j.ejvsvf.2022.01.015]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/17/2021] [Accepted: 01/27/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
The treatment of complex aortic disease has been described with various retrograde visceral bypass techniques. An original technique with a single stem retrograde visceral graft (SSRVG) is presented.
Methods
This was a single centre retrospective study including 16 patients between 2015 and 2019. Patients were treated for aortic dissection (AD; type A and acute or chronic type B), thoraco-abdominal aortic aneurysms (TAAAs), and visceral occlusive disease. Surgery consisted of visceral vessel debranching from the native infrarenal aorta or from an aortic graft. In the case of AD, surgical fenestration was performed. Additional thoracic endovascular aneurysm repair (TEVAR) completed the treatment when indicated, during the same procedure or later. Patient outcomes and reconstruction patency were studied.
Results
The mean patient age was 64 years (median 68 ± 12.6). Ten (62%) patients were treated for AD, three (19%) for TAAA, and three (19%) for occlusive disease. Sixty-nine target vessels were debranched with this SSRVG technique. Aortic surgical fenestration was performed in eight cases and TEVAR in four. During their hospital stay, three (19%) TAAA patients died, seven cases of renal insufficiency (44%), four cases of pneumonia (25%), and three colonic ischaemia cases (19%) were noted. After a mean follow up of 21 months, no other deaths occurred. All vessels (except two inferior mesenteric arteries) were patent and no endoleak was noted.
Conclusion
The SSRVG technique can be offered in various complex aortic diseases. The use of a single graft is feasible and reduces the volume of multiple branch assembly in the retroperitoneal space. The observed patency rate is high.
Not all patients with complex aortic disease are amenable to open surgery or total endovascular repair.
Hybrid surgery with visceral vessel debranching may represent an alternative.
Various techniques using several grafts to debranch visceral vessels have been published.
The use of a single conduit for total visceral debranching is relatively straightforward and provides excellent patency results.
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