Single Stem Visceral Debranching for Complex Aortic Disease

Objective: The treatment of complex aortic disease has been described with various retrograde visceral bypass techniques. An original technique with a single stem retrograde visceral graft (SSRVG) is presented. Methods: This was a single centre retrospective study including 16 patients between 2015...

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Main Authors: Jean-Michel Davaine, Jérémie Jayet, Léa Oiknine, Garance Martin, Thibault Couture, Dorian Verscheure, Fabien Koskas
Format: Article
Language:English
Published: Elsevier 2022-01-01
Series:EJVES Vascular Forum
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2666688X22000156
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author Jean-Michel Davaine
Jérémie Jayet
Léa Oiknine
Garance Martin
Thibault Couture
Dorian Verscheure
Fabien Koskas
author_facet Jean-Michel Davaine
Jérémie Jayet
Léa Oiknine
Garance Martin
Thibault Couture
Dorian Verscheure
Fabien Koskas
author_sort Jean-Michel Davaine
collection DOAJ
description Objective: The treatment of complex aortic disease has been described with various retrograde visceral bypass techniques. An original technique with a single stem retrograde visceral graft (SSRVG) is presented. Methods: This was a single centre retrospective study including 16 patients between 2015 and 2019. Patients were treated for aortic dissection (AD; type A and acute or chronic type B), thoraco-abdominal aortic aneurysms (TAAAs), and visceral occlusive disease. Surgery consisted of visceral vessel debranching from the native infrarenal aorta or from an aortic graft. In the case of AD, surgical fenestration was performed. Additional thoracic endovascular aneurysm repair (TEVAR) completed the treatment when indicated, during the same procedure or later. Patient outcomes and reconstruction patency were studied. Results: The mean patient age was 64 years (median 68 ± 12.6). Ten (62%) patients were treated for AD, three (19%) for TAAA, and three (19%) for occlusive disease. Sixty-nine target vessels were debranched with this SSRVG technique. Aortic surgical fenestration was performed in eight cases and TEVAR in four. During their hospital stay, three (19%) TAAA patients died, seven cases of renal insufficiency (44%), four cases of pneumonia (25%), and three colonic ischaemia cases (19%) were noted. After a mean follow up of 21 months, no other deaths occurred. All vessels (except two inferior mesenteric arteries) were patent and no endoleak was noted. Conclusion: The SSRVG technique can be offered in various complex aortic diseases. The use of a single graft is feasible and reduces the volume of multiple branch assembly in the retroperitoneal space. The observed patency rate is high.
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spelling doaj.art-be8affb4414542938b779b05d72b38da2022-12-22T01:11:42ZengElsevierEJVES Vascular Forum2666-688X2022-01-01551622Single Stem Visceral Debranching for Complex Aortic DiseaseJean-Michel Davaine0Jérémie Jayet1Léa Oiknine2Garance Martin3Thibault Couture4Dorian Verscheure5Fabien Koskas6Sorbonne Université, Faculté de Médecine Campus Pitié-Salpêtrière, Paris, France; Vascular Surgery Department, University Hospital Pitié-Salpêtrière, Paris, France; Corresponding author. Sorbonne Université, Faculté de Médecine Campus Pitié-Salpêtrière, Paris, France.Vascular Surgery Department, University Hospital Pitié-Salpêtrière, Paris, FranceVascular Surgery Department, University Hospital Pitié-Salpêtrière, Paris, FranceVascular Surgery Department, University Hospital Pitié-Salpêtrière, Paris, FranceVascular Surgery Department, University Hospital Pitié-Salpêtrière, Paris, FranceVascular Surgery Department, University Hospital Pitié-Salpêtrière, Paris, FranceSorbonne Université, Faculté de Médecine Campus Pitié-Salpêtrière, Paris, France; Vascular Surgery Department, University Hospital Pitié-Salpêtrière, Paris, FranceObjective: The treatment of complex aortic disease has been described with various retrograde visceral bypass techniques. An original technique with a single stem retrograde visceral graft (SSRVG) is presented. Methods: This was a single centre retrospective study including 16 patients between 2015 and 2019. Patients were treated for aortic dissection (AD; type A and acute or chronic type B), thoraco-abdominal aortic aneurysms (TAAAs), and visceral occlusive disease. Surgery consisted of visceral vessel debranching from the native infrarenal aorta or from an aortic graft. In the case of AD, surgical fenestration was performed. Additional thoracic endovascular aneurysm repair (TEVAR) completed the treatment when indicated, during the same procedure or later. Patient outcomes and reconstruction patency were studied. Results: The mean patient age was 64 years (median 68 ± 12.6). Ten (62%) patients were treated for AD, three (19%) for TAAA, and three (19%) for occlusive disease. Sixty-nine target vessels were debranched with this SSRVG technique. Aortic surgical fenestration was performed in eight cases and TEVAR in four. During their hospital stay, three (19%) TAAA patients died, seven cases of renal insufficiency (44%), four cases of pneumonia (25%), and three colonic ischaemia cases (19%) were noted. After a mean follow up of 21 months, no other deaths occurred. All vessels (except two inferior mesenteric arteries) were patent and no endoleak was noted. Conclusion: The SSRVG technique can be offered in various complex aortic diseases. The use of a single graft is feasible and reduces the volume of multiple branch assembly in the retroperitoneal space. The observed patency rate is high.http://www.sciencedirect.com/science/article/pii/S2666688X22000156Aortic dissectionHybrid surgeryTEVARThoraco-abdominal aortic aneurysmVisceral vessel debranching
spellingShingle Jean-Michel Davaine
Jérémie Jayet
Léa Oiknine
Garance Martin
Thibault Couture
Dorian Verscheure
Fabien Koskas
Single Stem Visceral Debranching for Complex Aortic Disease
EJVES Vascular Forum
Aortic dissection
Hybrid surgery
TEVAR
Thoraco-abdominal aortic aneurysm
Visceral vessel debranching
title Single Stem Visceral Debranching for Complex Aortic Disease
title_full Single Stem Visceral Debranching for Complex Aortic Disease
title_fullStr Single Stem Visceral Debranching for Complex Aortic Disease
title_full_unstemmed Single Stem Visceral Debranching for Complex Aortic Disease
title_short Single Stem Visceral Debranching for Complex Aortic Disease
title_sort single stem visceral debranching for complex aortic disease
topic Aortic dissection
Hybrid surgery
TEVAR
Thoraco-abdominal aortic aneurysm
Visceral vessel debranching
url http://www.sciencedirect.com/science/article/pii/S2666688X22000156
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