UMIN 000025388, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029229.

No abstract

A 71 year old male who had undergone extra-anatomic bypass grafting between the ascending aorta and the thoraco-abdominal aorta at 41 years of age for aortic coarctation was admitted with back pain and dyspnea. A 16 mm Cooley double velour knitted polyethylene terephthalate (PET) graft was used in the initial operation in 1983. Computed tomography showed disruption of the initial PET graft perforating the right atrium, and a pseudoaneurysm at the distal anastomosis. The patient was in acute cardiac failure because of left to right shunting. A two stage operation was performed. The first stage comprised emergency re-grafting and right atrium repair, and the second stage re-grafting for the pseudoaneurysm. The patient is doing well 48 months post-operatively; however, monitoring of the patient will continue for potential PET graft rupture.

15 (1+ in 8; 2+ in 5; 3+ in 2), and no organisms could be detected in 7. When abscess formation around FF occurred, 2 -3 sutures were removed, and drainage with lavage was continued for 2 e 6 weeks. FF re-suturing was necessary to prevent further dehiscence and FF swelling. The FF was fixed to the implantation floor, NPWT was applied.Results -There were 8 FF losses due to vessel complication, and 2 failing FFs due to vein graft stenosis. Of 8, 5 underwent successful redo FF. In redo FF, proximally long FF covering vessel pedicle and short vessel pedicle using aDVA were used to prevent vessel thrombosis, and 2-SO was effective to avoid inflow failure. Scapular FF were preferably used because of less calcified artery. FF partial dehiscence due to abscess formation occurred in 10 due to residual osteomyelitis or wound infection. Of 10, 9 were DM/HD, and remaining one was uncontrolled DM. Preoperative infection control reduced organisms, but was ineffective to prevent FF infection. FF failure occurred in 3, while remaining 7 achieved successful FF healing by the local management (Table).Conclusion -CBFF for ETL was effective LS option. However, vein thrombosis of FF was common cause of FF loss, and DM/HD frequently occurred FF infection. Long FF and short pedicle using aDVA were effective to prevent vessel thrombosis, and intensive local management with a fixation suture was effective on FF infection.

with passive arterial shunt and two-graft technique to reduce these ischemic complications. A first bifurcated graft is anastomosed laterally to the distal descending thoracic aorta, before left renal artery bypass and intraoperative perfusion of both superior mesenteric and right renal arteries. A second graft is used for in-line aneurysm reconstruction. We herein present our experience of type IV TAA open repair using this technique. Methods: Twenty-four patients (mean age, 68 years) underwent elective open repair for type IV TAA with this technique between January 2011 and December 2017. The intervention was achieved through a left thoracophrenic lumbotomy, with retroperitoneal and retrorenal approach. A bifurcated graft was anastomosed laterally to the distal descending thoracic aorta to bypass the left renal artery before aortic cross-clamping. The second limb of this bifurcated graft was connected to a Y-shaped cannula to simultaneously perfuse both superior mesenteric and right renal arteries during supraceliac aortic cross-clamping (Fig 1). An additional tube or bifurcated graft was then used for in-line aneurysm reconstruction. The visceral aortic patch was anastomosed to the aortic graft with the Crawford inclusion technique. The prosthetic limb graft used as a temporary arterial shunt was ligated at the end of the intervention; the left renal artery bypass was preserved as part of the definitive arterial reconstruction (Fig 2). Patients' records were analyzed for demographics, comorbidities, arterial lesions, operative variables, complications, and 30day mortality. Results: Mean left renal ischemia time was 10.5 minutes. Mean aortic cross-clamping was 31 minutes. The creatinine level at discharge was not significantly different from the preoperative level (15 vs 13; P ¼ .01). Three patients (12.5%) had transient renal failure (Acute Kidney Injury Network stage 1) postoperatively. Prolonged ventilatory support (>2 days) was necessary in two patients (8%). No cardiac event, no dialysis, and no multivisceral organ failure have been recorded. The postoperative mortality rate was 4% (one patient). Conclusions: Type IV TAA repair with our passive shunt and two-graft technique provides short visceral and renal ischemia times and leads to low rates of end-organ ischemic damages. This technique could be an option to consider for visceral protection in type IV TAA open repair and spurs us on to maintain it for our future cases.