A New Sutureless Telescoping Anastomotic Technique for Major Aortic Branch Revascularization With Minimal Dissection and Ischemia

Abstract

Aortic surgery involving major aortic branches (supraaortic trunks, visceral, renal arteries, and iliac arteries) is complicated by the requirement to dissect and occlude them during revascularization. We report an 8-year experience with a sutureless telescoping anastomotic technique to revascularize these branches with minimal branch dissection and organ ischemia. Over an 8-year period, 246 major aortic branches in 142 patients were revascularized by the following technique: After limited dissection of the most easily accessible wall of the target artery, a self-expanding but unexpanded stent graft, Viabahn (5-13 mm in diameter; 5-15 cm long) was introduced into a standard vascular graft (SVG) 1 mm less in diameter than the expanded stent graft. The target artery was punctured and over a guide wire the unexpanded stent graft was introduced 1 to 2 cm in artery. The SVG was advanced over the nondeployed stent graft up to the artery puncture site. Then the stent graft was deployed (partly in the branch and partly in the SVG). After balloon dilatation of the stent graft, the balloon and guide wire were removed and 2 stitches placed to penetrate the arterial wall and stent graft to fix it in the artery. Usually the proximal end of the SVG was already anastomosed to an aortic replacement graft, the aorta or an iliac artery before stent-graft branch revascularization was performed so that ischemia to the organs supplied by the aortic branch was minimized. This technique was used for revascularization of supraaortic trunks (45 target vessels), and renal and/or visceral arteries and/or hypogastric arteries (201 target vessels), mostly in debranching procedures to allow endovascular aneurysm repair. The immediate technical success rate was 98%. Overall mean ischemia time was less than 4 minutes. The 30-day patency rate was 94%, and the mid-term (4-5 year) patency rate was 91%. This technique simplifies and shortens performance of aortic branch revascularization during aortic reconstructions for aneurysmal or occlusive disease. It minimizes vessel dissection and ischemia time and is of particular value in hybrid procedures, anatomically challenging situations, and in extensive scarring encountered in redo surgery.