Novel sutureless telescoping anastomosis revascularization technique of supra-aortic vessels to simplify combined open endovascular procedures in the.

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Novel sutureless telescoping anastomosis revascularization technique of supra-aortic vessels to simplify combined open endovascular procedures in the treatment of aortic arch pathologies Konstantinos P. Donas, MD, Zoran Rancic, MD, Mario Lachat, MD, Thomas Pfammatter, MD, Thomas Frauenfelder, MD, Frank J. Veith, MD, Dieter Mayer, MD Journal of Vascular Surgery Volume 51, Issue 4, Pages 836-841 (April 2010) DOI: 10.1016/j.jvs.2009.09.054 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Octopus graft premounted ex vivo. A 16-mm expanded polytetrafluoroethylene graft is intended to bypass the brachiocephalic trunk. Onto this feeding graft (FG), three grafts are sutured as side branches that are intended to bypass the left subclavian artery and both carotid arteries. The Viabahn stent grafts will be introduced inside these interposition grafts (IG 1-3). Ideally, the IG will cover the Viabahn completely. Journal of Vascular Surgery 2010 51, 836-841DOI: (10.1016/j.jvs.2009.09.054) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 The aortic end-to-side anastomosis of the feeding graft has been performed. The Viabahn is introduced over a guidewire into the interposition graft and the left subclavian artery. Journal of Vascular Surgery 2010 51, 836-841DOI: (10.1016/j.jvs.2009.09.054) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 The Viabahn has been deployed into the left subclavian artery, and blood flow has been restored through the interposition graft. Full expansion of the Viabahn is achieved by balloon inflation, which is responsible for several short periods of blood flow interruption. Journal of Vascular Surgery 2010 51, 836-841DOI: (10.1016/j.jvs.2009.09.054) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 The left subclavian artery and both carotid arteries have been revascularized with the Viabahn technique and the right subclavian artery with a conventional end-to-side running suture on the level of the brachiocephalic trunk. The Viabahn stent grafts have been secured with transparietal 6-0 stitches and the native vessels have been interrupted proximally to the anastomosis by ligation or clip application. Journal of Vascular Surgery 2010 51, 836-841DOI: (10.1016/j.jvs.2009.09.054) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 Reconstruction of the follow-up computed tomography angiography shows a Viabahn (internal diameter, 8 mm; length, 5) that was implanted a year earlier into the left subclavian artery. No evidence of stenosis at the distal end (DE) of the Viabahn was recorded. The left vertebral artery (LVA) is patent. Journal of Vascular Surgery 2010 51, 836-841DOI: (10.1016/j.jvs.2009.09.054) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 6 Postprocedural computed angiography in an 86-year-old patient with a 7.5-cm isolated arch aneurysm. Viabahn debranching was performed on the left subclavian and both carotid arteries. The feeding graft was implanted into the ascending aorta, just above the sinotubular junction. A pacemaker wire was used to mark the ostium of the feeding graft. The feeding graft lands end-to-side into the brachiocephalic trunk and revascularizes the right subclavian artery. Journal of Vascular Surgery 2010 51, 836-841DOI: (10.1016/j.jvs.2009.09.054) Copyright © 2010 Society for Vascular Surgery Terms and Conditions