Results of the Gore Hybrid Vascular Graft in Challenging Aortic Branch Revascularization during Complex Aneurysm Repair

Abstract

Prolonged organ ischemia during complex aortic surgery is associated with increased morbidity and mortality. A novel hybrid graft (Gore Hybrid Vascular Graft) ascomposite of expanded polytetrafluorethylene vascular prosthesis that has a section reinforced with nitinol was investigated for feasibility and effectiveness during aortic repair. Retrospective analysis of all consecutive patients treated with the hybrid vascular graft (HVG). Indication for graft implantation was surgeon's preference for branch revascularization in challenging aortic repair. Within 26months, 25 Gore HVGs and 17 conventional grafts were implanted in 12 patients (age, 73years; range, 33-79 years, 8 men). Eleven patients were treated for thoracoabdominal aortic aneurysms and one for aortoiliac aneurysm (elective=6, urgent=6). Nine visceral debranching procedures, 2 Crawford procedures, and 1 repair of an internal iliac aneurysm were performed. The distribution of HVG use was left renal artery=10, right renal artery=9, superior mesenteric artery=4, celiac trunk=1, and internal iliac artery=1. Time to restore visceral blood flow during visceral debranching was 7±4min for the Gore HVG vs. 12 ± 6min for conventional grafts (P<0.01).Technical success was achieved in all cases. At 12months of median follow-up, cumulative patency of the HVGs was 96%. The Gore HVG offers a new, simplified, and time-sparing technique for visceral anastomoses during complex aneurysm repair. However, long-term results are still lacking and need to be awaited.