Elective Open Repair with “Debranch, Perfuse, Reconstruct” Technique to Treat Suprarenal or Type IV Thoracoabdominal Aortic Aneurysms

Abstract

Open surgical repair of suprarenal abdominal aortic aneurysm (SRAAA) and type IV thoraco-abdominal aortic aneurysm (TAAA) remains a surgical challenge because of the inducted intraoperative visceral and renal ischemia. We reported a novel three-step technique named "Debranch, Perfuse, Reconstruct" (DPR), using debranching and passive arterial shunt to reduce these ischemic complications. The main aim of this study was to evaluate the 30-day and 1-year mortality of these DPR technique. The secondary aim was to evaluate the impact on renal function and the primary patency of the repaired arteries METHODS: This retrospective study included all consecutive patients who underwent elective surgery for SRAA or type IV TAAA using DPR technique between January 2011 and June 2022. Debranch: Using partial side clamping, a multibranch graft was implanted side-to-end into the descending thoracic aorta. The left renal artery (LRA) was anastomosed end to end to the graft. As needed, the superior mesenteric artery (SMA), the celiac trunk (CT), and the right renal artery (RRA) could also be anastomosed to the graft. Perfusion: cannulas were connected to the last branch of the multibranch graft to perfuse other arteries during aortic cross-clamping. Repair: a tube or bifurcated graft was used for the aortic repair. The branch used as a passive temporary arterial shunt were ligated at the end of the intervention. Clinical, radiological, and biological pre- and postoperative were reviewed using a standardized database. Procedural complications and re-interventions were analyzed as well as artery patency. There were 40 patients who underwent DPR technique, the mean age was 67 ± 13 years, 2 women.: 23 patients presented with a SRAA et 17 with a type IV TAAA. The 30-day and 1-year mortality rate were 2.5% (one patient). Two respiratory complications (5%) and three mesenteric ischemic complications (7%) have been recorded. No patient developed signs of cardiac or spinal cord dysfunction. We did not observe a significant change in postoperative renal function. CT, SMA, LRA, and RRA bypass patency rates at one year were 95%, 100%, 90%, and 100%, respectively. The SRAA and type IV TAAA repair with DPR technique provides short visceral and renal ischemia times with a low mortality rate. This technique could be an option to consider for visceral and renal protection during open surgical repair.