A New Approach For Replacement Of Thoracoabdominal Aorta
Fabio Scigliano1, Ettorino Di Tommaso1, Antonio Mariniello1, Loredana Grande2, Sergio Palumbo1, Luigi Di Tommaso1, Gabriele Iannelli1.
1Department of Cardiac Surgery A.O.U. Federico II, Napoli, Italy, 2Department of Anesthesiology A.O.U. Federico II, Napoli, Italy.
Background: Fenestrated Endovascular Treatment for thoraco-abdominal aorta still carries serious limits and complications (endoleaks, redo and rupture). Hybrid approach, a promising option, leaves the aneurysmatic sac and is a time-consuming and expensive procedure. Conventional surgery for thoraco-abdominal aortic aneurysms, even if hampered by high mortality with neurological and visceral complications, remains the gold standard because minimizes the risk of visceral ischemia, limits the risk of paraplegia and avoids any circulatory support.
Methods: The modified graft is connected proximally to the Left Subclavian Artery (LSA) and distally to both iliac arteries by shunt branches. Graft body and branches are cross clamped and blood flows antegrade through the graft and thoraco-abdominal aorta. All visceral branches are revascularized with very limited ischemia time while the patent thoraco-abdominal aorta perfuses thoracic and lumbar arteries. Then aorta is cross clamped between LSA and sixth thoracic artery level . Thoracic arteries are ligated and an anastomosis between graft and aortic neck is performed while shunts perfuse the supraceliac critical area. The cross clamp moves to the infrarenal aorta. LSA shunt branch is interrupted and sutured to the critical area (“ cobra-head technique “). During this step lumbar and limbs arteries are perfused by shunts. The origin of iliac arteries is clamped above shunt branches. Abdominal aorta is opened and lumbar arteries ligated an end to end anastomosis between graft and distal abdominal aorta is performed while limbs are perfused by shunt branches. At the end, also distal shunt branches are ligated.
Results: We conducted an experimental study on five pigs undergone thoracoabdominal aorta replacement with a modified vascular shunt graft. Technical success was obtained in three pigs.
Conclusions: Obviously, despite our encouraging results, more cases are required to get conclusion.
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