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Renal and Visceral Sutureless Anastomosis During Thoracoabdominal Aortic Repair

  • Andrea KahlbergEmail author
  • Matteo Bossi
  • Daniele Mascia
  • Enrico Rinaldi
  • Yamume Tshomba
  • Germano Melissano
  • Roberto Chiesa
Chapter

Abstract

Perioperative renal failure is still one of the most feared complications of thoracoabdominal aortic aneurysm (TAAA) open repair and represents a strong predictor for early and late mortality. Despite improvements in renal cold protection, a key role for renal function preservation is played by the reduction of ischemic time: this aspect can be obtained by different techniques for renal reconstruction. Moreover, the possibility of vessel damaging and early occlusions must be considered upon deciding the operating technique.

Similar topics must be considered for the visceral vessels, especially for those far away and difficult to expose.

The use of the Gore Hybrid Vascular Graft (GHVG) with distal sutureless anastomosis for the separate reattachment of both renal and visceral vessels during TAAA open repair has proven to be feasible and safe, especially in cases of remote location of the vessel origin or with severe atherosclerotic disease of the ostium.

Supplementary material

Movie 19.1

Video showing Gore Hybrid Vascular Graft (GHVG) deployment during TAAA open repair. The GHVG is gently placed into the artery for 2–3 cm. The stent is released and ballooned after deployment. The cold renal perfusion catheter is then immediately reinserted into the graft. Of note stiches for fixation of GHVG to the renal artery and device. Finally, the proximal anastomosis to the main aortic graft is completed (AVI 189508 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andrea Kahlberg
    • 1
    Email author
  • Matteo Bossi
    • 1
  • Daniele Mascia
    • 1
  • Enrico Rinaldi
    • 1
  • Yamume Tshomba
    • 2
    • 3
  • Germano Melissano
    • 1
  • Roberto Chiesa
    • 4
  1. 1.Vascular SurgeryVita-Salute University School of Medicine, San Raffaele Scientific InstituteMilanItaly
  2. 2.Unit of Vascular SurgeryFondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro CuoreRomeItaly
  3. 3.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly
  4. 4.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly

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