Patency and durability of presewn multiple branched graft for thoracoabdominal aortic aneurysm repair.

Abstract

The use of an aortic patch containing the visceral and renal arteries is a well-established technique during thoracoabdominal aortic aneurysm (TAAA) repair. However, the retained aortic tissue may later become aneurysmal. We reviewed our TAAA repair experience using a presewn aortic branched graft to eliminate this risk. Between March 2003 and December 2008, 52 patients with Crawford extent II and III TAAAs had surgical repair using a presewn aortic branched graft. Postoperative computed tomography (CT) scans with intravenous contrast were available for 41 patients (mean angiographic follow-up 2.3 years). The mean age of these 41 patients was 59 +/- 16 years (range, 22-86), and 21 patients were female (51%). The indications for surgery were degenerative aneurysms in 30 patients (73%), type B dissections in 10 patients (24%), and visceral patch aneurysm in 1 patient (2.4%). Twenty-four patients (59%) underwent repair of a Crawford extent II TAAA and 17 patients (41%) had extent III TAAA repair. Patency of the branches to the visceral and renal arteries at 1 and 5 years was 100% and 98%, respectively. Of the 148 graft branches, 2 became occluded and 4 developed stenosis (2 patients). One patient required percutaneous stenting of 3 stenosed branches, and 1 patient died after acute occlusion of 2 branches and stenosis of a third. During the follow-up period that extended to 6.3 years, there were 10 late deaths. Six patients required reoperation on the aortic graft or contiguous aorta, but no reoperations have been required on the visceral abdominal aorta or its branches. The use of a presewn aortic branched graft is a safe and suitable option for TAAA repair. With midterm follow-up, this technique seems to eliminate the risk of visceral patch aneurysms and results in favorable durability and patency.