Reconstruction of the intercostal arteries with small-branched grafts in patients with thoracoabdominal or descending aortic aneurysms.

An extent II thoracoabdominal aortic aneurysm of 60 mm diameter was exposed through the left 6(th) intercostal space and retroperitoneal approach. The partial cardiopulmonary bypass was initiated through the femoral arterial and venous cannulation. A knitted Dacron graft of 22 mm with four spatially orientated branches for the abdominal viscera and five branches for the intercostal arteries was utilized. The thoracoabdominal aorta was replaced with staged segmental aortic clamping. The proximal aorta, just distal to the left subclavian artery, was completely transected and anastomosed to the graft. The descending aorta was clamped at Th 10 level. The Th 8 and 9 intercostal arteries were clamped from the outside of the aorta. After opening the aorta, the left orifice of Th 8(th) and Th 9(th) intercostal arteries were anastomosed to the side branches of the graft, respectively. Similarly, the 10(th) and 11(th) intercostal arteries were reconstructed. After clamping the infra-renal portion of the abdominal aorta, four visceral arteries were perfused using an 8 French size balloon-tipped catheter. Each artery was anastomosed to the side branch of the graft. The distal anastomosis was performed and cardiopulmonary bypass was weaned-off.