Patency of branch vessels reimplanted during thoraco-abdominal aortic replacement: implications for the surgical technique.

OBJECTIVES

Reimplantation of branch vessels is an important component of thoraco-abdominal aortic aneurysm repair. The goal of this study was to assess the anatomical results of branch vessel reimplantation, which have rarely been investigated.

METHODS

Among 168 patients who underwent computed tomography after thoraco-abdominal aortic aneurysm repair, the technique of branch vessel reimplantation and determination of their patency were investigated. Late computed tomographic images were available for 81 patients (mean interval 55.7 ± 29.4 months); they were examined for long-term changes.

RESULTS

The early patency rate of the coeliac trunk (n = 150), superior mesenteric artery (n = 126) and right renal artery (n = 109) was 100%, regardless of the reimplantation technique. For 101 left renal arteries reimplanted end-to-end to the branch grafts, the early patency rate was 94.1%. Late new occlusion was found in 1 of 44 (2.3%) of the right renal arteries and in 1 of 53 (1.9%) of the left renal arteries reimplanted into the branch grafts. The patency rate of 240 segmental (intercostal or lumbar) arteries reimplanted in 116 patients differed based on the reimplantation technique used: 92.1% for a large multiple-branch patch, 83.0% for a single-branch patch and 31.0% for graft interposition. Spinal cord ischaemia was significantly more frequent in patients who had occlusion of reimplanted segmental arteries than in the remaining patients: 18.2% vs 4.4% (P = 0.022). Late computed tomography revealed ≥5 mm dilatation in 2 of 41 visceral branch patches (4.9%) and in 9 of 55 segmental artery patches (16.4%).

CONCLUSIONS

Visceral branches reimplanted during thoraco-abdominal aortic aneurysm repair showed excellent patency. In contrast, segmental artery reimplantation by graft interposition showed a high rate of occlusion that was associated with a higher incidence of spinal cord ischaemia.