The Gore Hybrid Vascular Graft in renovisceral debranching for complex aortic aneurysm repair

Abstract

we analyzed outcomes of 13 patients who underwent open surgical debranching of renovisceral vessels for thoracoabdominal aortic aneurysm and PAAAs. All patients were considered at high risk for conventional surgery. Inclusion criterion was treatment by open surgical debranching of at least one visceral artery (renal artery, superior mesenteric artery [SMA], or celiac trunk [CT]) using the GHVG. In a second step, the aortic stent graft was implanted to exclude the aneurysm. If required, parallel grafts to the remaining visceral arteries were deployed in the same procedure. One patient had a symptomatic descending thoracic aortic aneurysm and another had a ruptured PAAA. Perioperative measured outcomes were immediate technical success rate, mortality, and morbidity. Median follow-up was 24.8 months (range, 0-15; mean, 8.2; standard deviation, 4 months).Results: All open surgical debranching of renovisceral vessels were completed as intended. GHVG was used to revascularize 20 visceral vessels in 13 patients with a mean of 1.54 vessels per patient. Six renal arteries (30%; 2 right and 4 left), 9 SMAs (45%), and 5 CTs (25%) were debranched. In nine of 13 (66%) patients, other renovisceral arteries were addressed with chimney/periscope, Viabahn Open Revascularization Technique, and end-to-side anastomosis. Two of 13 patients (15%) died of bowel ischemia. Neither patient had GHVG revascularization to the SMA or CT. Perioperative complications occurred in three patients (23%; 1 renal hematoma, 1 respiratory insufficiency, and 1 small-bowel ischemia related to a SMA GHVG thrombosis). At 24 months, estimated survival was 85%, and estimated primary and secondary patency were 94% and 100%, respectively. Conclusions: This limited series extracted from a more consistent hybrid procedure experience showed a mortality rate similar to most recent reports. Technical feasibility and the short-term patency rate of the GHVG for renovisceral debranching during staged hybrid open and endovascular procedures were satisfactory. Use of GHVGs may represent a useful revascularization adjunct to minimize visceral ischemia in these challenging patients. (J Vasc Surg 2016;64:33-8.)

Total robotic iliac aneurysm repair with preservation of the internal iliac artery using sutureless vascular anastomosis

“…Whereas the long-term outcomes of GHVG remain to be seen, multiple authors have reported excellent short-term patency (92%-94%) of visceral vessels treated in this manner 8, 18. Important limitations of this technique include the risk of autonomic nerve injury due to CIA dissection (particularly on the left), risk of iliocaval injury, high EBL, and long operative time.…”

“…A physician-made hybrid vascular graft created by sewing endovascular iliac limbs to the limbs of a conventional polyester bifurcated graft has previously been described to reduce operative time during open abdominal aortic aneurysm repair and could be applicable to a robotic approach 5 . The Gore Hybrid Vascular Graft (GHVG; W. L. Gore & Associates, Flagstaff, Ariz) has been used to revascularize vessels in difficult locations, such as the distal internal carotid artery,6, 7 as well as renal and visceral arteries during thoracoabdominal repair 8 . Combining this sutureless anastomotic technique with the robotic approach allows us to access, control, and reconstruct the iliac system more easily as it greatly facilitates deep pelvic dissection and circumferential vessel anastomosis.…”

Commentary: Physician-Modified Fenestrated/Branched EVAR and Hybrid Techniques for Acute Thoracoabdominal Aortic Pathologies: Inequality When Comparing Alternative Options With Different Philosophies Does Not Equal Lower Quality

“…Generally, one should also have in mind the Vortec technique to reduce the number of anastomoses; in this method a self-expanding stent-graft is deployed in the target vessel using the Seldinger technique and then is anastomosed to the graft, reducing the operating and flow cessation time to the viscera. 30 Interestingly, a common disadvantage of the method encountered is the appearance of endoleaks. 23 In a recent study, a reintervention rate of 12% after hybrid repair due to endoleaks has been emphasized.…”

Current Trends of Treatment Options for Complex Aortic Pathology with Visceral Artery Involvement in a Large Single-Center Experience

“…Hybrid repair can be a valid alternative and is more often considered since the VORTEC technique was first described [14]. In the examined amount of time, we only used this technique once.…”