Experimental Model for Sutureless Proximal Anastomosis by the ViaBahn Open Revascularization Technique (VORTEC)

Abstract

IntroductionIn the treatment of complex aneurysms, debranching is an extra-anatomical revascularization of visceral arteries followed by endograft coverage of the thoracoabdominal aorta. It eliminates the need for a thoracotomy and aortic clamping, but requires the performance of several technically demanding visceral anastomosis. In 2008, Lachat described visceral revascularization with the use of a sutureless distal anastomosis, performed by the telescoping of an endograft in the visceral branch, named VORTEC (Viabahn Open Revascularization TEChnique).ObjectiveAn experimental model was created to test the feasibility and short term results of performing a telescoped proximal anastomosis to the abdominal aorta.MethodsSwine model. The abdominal aorta was dissected and ligated between the renal arteries and the iliac vessels. Three centimeters bellow the renal arteries a Viabahn endograft was telescoped for 2 cm into the proximal aorta. The other extremity was conventionally anastomosed to the distal aorta. Patency, sealing and tensile strength of the anastomosis were tested.ResultsTime for performing the telescoped anastomosis was shorter (5.4±2.8 min versus 10.3±3.4 min, P<0.05). All grafts were patent and both types of anastomosis presented no bleeding. Immediate tensile strength showed a higher strength of the conventional suture (22.7 x 14.3 N, P<0.09). After 30 days there was no pseudo-aneurysms and the strength of the conventional and VORTEC anastomosis were similar (37.3 x 40.8 N, respectively, P=0.17).ConclusionTelescoped proximal anastomosis by the technique of VORTEC is feasible. After 30 days the tensile strength of the both anastomosis were similar.

Aperfeiçoando um modelo de treinamento para técnicas cirúrgicas vasculares

“…1,5 However, construction of vascular anastomoses requires significant exposure, dissection, and temporary occlusion of the vessel, increasing the risk of complications, particularly when performed by an inexperienced surgeon. 6 The best way to acquire and develop this skill is through training with experimental models. 4 Simulators are inanimate models developed for training a specific technical or motor skill; and simulations are the various different situations in which use of this technical skill is part of the competence being trained.…”

“…3,4 There are many different biological models for practicing vascular anastomoses, mostly involving animal viscera. [4][5][6][7] The current initiative within the scientific community is to diversify use of already-existing teaching models to continue the trend to reduce use of animals, in addition to reducing risks and optimize surgery time in humans. 4,5…”