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Abstract
Introduction
Despite a high rate of success when performed in specialised centres, current techniques for thoracoabdominal aortic repair are associated with serious complications. The problem of spinal cord ischaemia remains unsolved.
Surgical technique
The new hybrid graft for thoracoabdominal aortic repair was developed based on the “frozen elephant trunk” principles. The device consists of a proximal stent graft for transabdominal retrograde delivery to the descending thoracic aorta, combined with a distal six branched abdominal device for open aortic repair. An additional seventh branch is provided for possible lumbar artery re-implantation. As the stent graft is implanted via a transabdominal approach, it avoids the need for thoracotomy and extracorporeal circulation. A 56 year old patient with Loeys–Dietz syndrome was placed in a supine position. The aortoiliacal axis was exposed via a midline laparotomy and transperitoneal approach. Following an end to side anastomosis of the iliac branch to the left common iliac artery, the stent graft portion was inserted into the thoracic aorta via the coeliac trunk ostium. After stent implantation and graft de-airing via needle puncture, retrograde blood flow to the abdominal aortic segment, and the lumbar and visceral arteries was established via the end to side anastomosis creating an extra-anatomical bypass. Subsequently, the visceral and renal arteries were anastomosed to the branches. Finally, the aorta was opened and surgical graft attached via the collar. The reconstruction ended with end to end anastomoses of both common iliac arteries to the graft branches.
Discussion
The first and successful implantation of the new Thoracoflo hybrid device via a novel surgical technique is reported, eliminating the need for thoracotomy and extracorporeal circulation for thoracoabdominal aortic repair.
Keywords
Article info
Publication history
Accepted:
February 20,
2023
Received in revised form:
February 13,
2023
Received:
December 16,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 The Author(s). Published by Elsevier Ltd on behalf of European Society for Vascular Surgery.
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