New Technique to Facilitate Renal Revascularization with Use of Telescoping Self-Expanding Stent Grafts: VORTEC

Abstract

This article describes a new, less invasive prosthetic graft anastomotic technique that uses selfexpanding stent grafts that are "telescoped" into aortic branches. This method, the VORTEC (Viabahn Open Revascularization TEChnique), obviates the need for potentially difficult complete vessel exposure and graft anastomoses, thereby reducing the duration of flow interruption and simplifying the performance of complex aortic reconstructions and so-called debranching procedures requiring reconstruction of major branches such as renal arteries. Minimal exposure of one surface of the renal artery allowed introduction and deployment of a self-expanding Viabahn (W.L. Gore Associates, Flagstaff, AZ) device using the Seldinger technique. The Viabahn devices used were 5 to 8 mm in diameter and 5 to 15 cm in length depending on individual anatomy (assessed by preoperative computed tomographic angiography). Overall, 82 renal arteries have been revascularized in 58 patients using the VORTEC. The technical success rate was 100%, with all of the stent grafts implanted as intended with maintenance of flow. The patency rates were 97% after 30 days and 96% after a mean follow-up of 18 months (range 1-38 months). The VORTEC allows performance of safe and expeditious revascularization of renal arteries. This new technique may represent significant improvement over the standard approach of surgical exposure and sutured anastomosis.

Five-year Patency Rates of Renal and Visceral Bypasses after Abdominal Debranching for Thoraco-abdominal Aortic Aneurysms

“…This technical problem might be avoided by applying the Kocher manoeuvre or using the Viabahn open rebranching technique (VORTEC) technique. 38 We detected only one late occlusion of a renal bypass graft after 2.3 years, which, based on the CT imaging, appeared due to a kinking of the graft near the anastomosis. Encouragingly, we did not reveal any occlusion of the hepatic/truncal graft.…”

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

“…Two selfexpanding stent grafts (VIABAHN, W.L. Gore & Associates, Flagstaff, Ariz.) based on the feeding graft enabled retrograde renal revascularisation [15]. Subsequent ultrasound and MDCTA confirmed graft patency before EVAR.…”

“…Because of the limited experience with patients undergoing the hybrid approach, experience in hybrid-specific imaging is lacking. Moreover, in our institution VORTEC (Viabahn open revascularisation technique) is applied to most renal arteries and frequently to the visceral arteries [15]. This technique requires a detailed analysis of the target vessels in order to implant the appropriate stent-graft device.…”

Endograft connector technique to treat popliteal artery aneurysm in a morbid obese patient

“…1 Recently, ECs have been increasingly used and reported in the medical literature, especially for revascularization of the visceral arteries. [2][3][4][5][6] However, only the recent improvements in techniques and medical devices have allowed the use of such anastomotic concept in vascular surgery. Herein, we report a case when an EC was employed to perform the distal anastomosis in a below-knee (BK) femoro-popliteal (fem-pop) bypass in a morbid obese patient who had a large symptomatic popliteal artery aneurysm (PAA).…”