Clampless aortic punch system for making a large-diameter access route without side-biting clamp: a preliminary study

  • Ryosuke Kowatari
  • Ikuo FukudaEmail author
  • Tomonori Kawamura
  • Yasuyuki Suzuki
Brief Communication Blood Vessel Prosthesis


Although thoracic endovascular aneurysm repair (TEVAR) has been getting popularity as a less-invasive procedure, the treatment of thoracic aortic aneurysm with atherosclerotic aortic disease is still challenging. In hybrid TEVAR through the median sternotomy approach, side-biting clamp of the ascending aorta is often necessary for making an access route; however, it could cause embolic complication and aortic dissection. This study aimed to present the results of our preliminary study on the clampless aortic punch system (APS). The swine aorta was used as experimental specimen (diameter 16–20 mm). A 10-mm collagen-impregnated knitted Dacron graft was anastomosed to the aorta, and the APS was inserted into it. After piercing the aorta with the inner fish hook of the APS, the aortic wall was scooped out by an outer round cutter. Three different-angled cutters (0°, 15°, and 30°) were tested three times. The diameter of the punched-out lesion ranged from 6 to 9 mm (median 8 mm). Macroscopically, no major vessel injuries were seen 15° series, whereas minor or major vessel injuries were seen 30° and 0° series, respectively. Histological findings of 15° series confirmed the sharp edge of the stump and abrupt interruption of the elastic fiber without destruction of the normal three-layer structure of the aortic wall. This study suggests that our clampless APS could reduce the risk of stroke and aortic injury in hybrid TEVAR, and an animal study confirming its utility is now under consideration.


Aortic punch Thoracic endovascular aneurysm repair Clampless 



This study was supported by grants-in-Aid for Scientific Research 15K10231. We are grateful to Dr. Hanae Sasaki for helping this experiment and making histological specimen.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.


  1. 1.
    von Allmen RS, Gahl B, Powell JT. Editor’s choice—incidence of stroke following thoracic endovascular aortic repair for descending aortic aneurysm: a systematic review of the literature with meta-analysis. Eur J Vasc Endovasc Surg 2017;53:176–84.Google Scholar
  2. 2.
    Vivacqua A, Albacker TB, Roselli EE. Hybrid thoracoabdominal aneurysm repair with antegrade visceral debranching from the ascending aorta: concomitant cardiac surgery and stent-grafting. Ann Thorac Surg. 2011;92:2275–7.CrossRefGoogle Scholar
  3. 3.
    Abdulamit T, Mangialardi N, Petrosyan A, Costa P, Albrand JJ, Trastour JC, Bergeron P. Aortic debranching from the ascending aorta: a novel surgical approach for extended TAAA and chronic type B dissections in high risk patients. J Cardiovasc Surg. 2012;53:345–53.Google Scholar
  4. 4.
    Pawliszak W, Kowalewski M, Raffa GM, Malvindi PG, Kowalkowska ME, Szwed KA, Borkowska A, Kowalewski J, Anisimowicz L. Cerebrovascular events after no-touch off-pump coronary artery bypass grafting, conventional side-clamp off-pump coronary artery bypass, and proximal anastomotic devices: a meta-analysis. J Am Heart Assoc. 2016;5:e002802.CrossRefGoogle Scholar
  5. 5.
    Salenger R, Rodriquez E, Efird JT, Gouge CA, Trubiano P, Lundy EF. Clampless technique during coronary artery bypass grafting for proximal anastomoses in the hostile aorta. J Thorac Cardiovasc Surg. 2013;145:1584–8.CrossRefGoogle Scholar
  6. 6.
    Bhutia SG, Wales L, Jackson R, Kindawi A, Wyatt MG, Clarke MJ. Descending thoracic endovascular aneurysm repair: antegrade approach via ascending aortic conduit. Eur J Vasc Endovasc Surg. 2011;41:38–40.CrossRefGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2019

Authors and Affiliations

  1. 1.Department of Thoracic and Cardiovascular SurgeryHirosaki University School of MedicineHirosakiJapan

Personalised recommendations