Technical aspects of branched graft aortic reconstruction in patients with connective tissue disorders Natalia O. Glebova, MD, PhD, Caitlin W. Hicks,

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Presentation transcript:

Technical aspects of branched graft aortic reconstruction in patients with connective tissue disorders Natalia O. Glebova, MD, PhD, Caitlin W. Hicks, MD, MS, Ridwan Alam, BS, Jennifer Lue, BA, Brandon W. Propper, MD, James H. Black, MD Journal of Vascular Surgery Volume 64, Issue 2, Pages 520-525 (August 2016) DOI: 10.1016/j.jvs.2016.04.044 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Considerations for visceral segment reconstruction in aortic repair. A, Three-dimensional reconstruction of computed tomography angiography of visceral patch aneurysms 19 years after thoracoabdominal aortic aneurysm (TAAA) repair in a 44-year-old woman with Loeys-Dietz syndrome, including a 2.3-cm aneurysm at the origin of the celiac axis (white arrow) and a 5.5-cm aneurysm at the origins of the superior mesenteric and right renal arteries (black arrow). B, Intraoperative photograph of visceral patch aneurysm repair in the patient in (A) with a Dacron patch across the superior mesenteric artery and celiac origins and a 16- × 8-mm bifurcated Dacron graft for bypass of the superior mesenteric artery and celiac axis (after a hepato-right renal artery bypass). C, Three-dimensional computed tomography angiography of a 7.5-cm degenerative type II TAAA in a 64-year-old woman. Note the long distances between visceral branch origins (arrow). D, Three-dimensional computed tomography angiography of branched graft aortic reconstruction in the patient from (C) 7 months postoperatively. Journal of Vascular Surgery 2016 64, 520-525DOI: (10.1016/j.jvs.2016.04.044) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Technical aspects of using branched grafts for aortic reconstruction in patients with connective tissue disorder (CTD). A, Exposure of thoracoabdominal aortic aneurysms (TAAAs). Incision sites in the appropriate intercostal space (ICS) corresponding to the type of aneurysm are indicated with dashed lines. B, Illustration of aortic repair with previously existing thoracic stent graft used for proximal anastomosis to a branched graft. Notice the adjunctive use of felt (inset) in situations with poor tissue quality. C, Illustration of Vascutek Gelweave Plexus Graft made for the aortic arch used for repair of TAAA. Note wrapping of graft branches around the main tube graft to achieve optimal graft configuration in relation to visceral arteries once the retroperitoneum is allowed to fall back in place at the conclusion of the operation. D, Illustration of Vascutek Gelweave Coselli Thoracoabdominal Graft use in aortic reconstruction. Note adjunctive use of felt for reinforcement of the aortic anastomoses. Journal of Vascular Surgery 2016 64, 520-525DOI: (10.1016/j.jvs.2016.04.044) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Repair of an intercostal patch aneurysm in a patient with connective tissue disorder (CTD). A, Three-dimensional computed tomography angiography of a 5.2-cm T9-T11 intercostal patch aneurysm in a 32-year-old man with Marfan syndrome 14 years after a thoracoabdominal aortic aneurysm (TAAA) repair. B, Aortogram of patient in (A). C, Endovascular stent graft repair of intercostal patch aneurysm in patient from (A) and (B). Journal of Vascular Surgery 2016 64, 520-525DOI: (10.1016/j.jvs.2016.04.044) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Branched grafts in aortic reconstruction for thoracoabdominal aortic aneurysm (TAAA) repair in patients with CTD. A, Three-dimensional computed tomography angiography of a rapidly growing type V TAAA in a 43-year-old woman with Marfan syndrome and type B dissection. B, Seven-month postoperative three-dimensional computed tomography angiography of aortic repair using a branched graft in the patient in (A). C, Eight-month postoperative three-dimensional computed tomography angiography of aortic repair using a branched graft in a 48-year-old woman with Marfan syndrome and a 6-cm type II TAAA showing right renal artery bypass wrapping around the aortic tube graft (arrow). Journal of Vascular Surgery 2016 64, 520-525DOI: (10.1016/j.jvs.2016.04.044) Copyright © 2016 Society for Vascular Surgery Terms and Conditions