Hybrid Gore Vascular Graft: A New Tool for the Hybrid Treatment of Thoraco-Abdominal Aneurysms

Abstract

The Hybrid procedure, first performed in 1999 by QuinonesBaldrich and colleagues [1], has been proposed for thoracoabdominal aneurysms (TAAA) repair as a less invasive technique than the traditional open surgery (avoiding both thoracophreno-laparotomy and aortic cross-clamping): in our Institute, the Hybrid technique has been performed since 2005 [2]. Since then, Literature showed several disadvantages: the overall duration of the procedure due to extensive dissections to prepare each visceral vessel and to make 5 to 7 anastomoses and the length of end-organ ischemia during the execution of each anastomosis (15 to 30 minutes) can cause critical rates of post-operative organ failure, morbidity and mortality [3]. Furthermore, nowadays total endovascular techniques make the Hybrid repair less attractive, but it can still be useful when you don’t have enough time (at least 3-4 weeks) to develop customized endovascular prosthesis. The new Gore® Hybrid Vascular Graft (HVG) can be a useful tool because it allows performing a “sutureless anastomosis” in a few minutes, and minimizes both the ischemia time of the target organ and the overall length of the operation. Effectively, this device is an ePTFE heparin bonded vascular prosthesis which has a section reinforced with nitinol. This part is partially constrained into a tubular shape to allow for easy insertion and deployment into a vessel. Gore® HVGs Instruction for Use (IFU) presents the device as a vascular prosthesis for replacement or bypass of diseased vessels in patients suffering occlusive or aneurysmal disease, for dialysis access, and in each patient requiring vascular replacement.