Department of Vascular Surgery, Nancy Regional University Hospital, Nancy, France.
Department of Vascular Surgery, Nancy Regional University Hospital, Nancy, France.
J Vasc Surg. 2024 Dec;80(6):1668-1675. doi: 10.1016/j.jvs.2024.08.025. Epub 2024 Aug 22.
Open surgical repair of suprarenal abdominal aortic aneurysm (SRAAA) and type IV thoracoabdominal aortic aneurysm (TAAA) remains a surgical challenge because of the inducted intraoperative visceral and renal ischemia. We report a novel three-step technique named debranch, perfuse, reconstruct (DPR), using debranching and passive arterial shunt to decrease these ischemic complications. The main aim of this study was to evaluate the 30-day and 1-year mortality rates associated with these DPR technique. The secondary aim was to evaluate the impact on renal function and the primary patency of the repaired arteries.
This retrospective study included all consecutive patients who underwent elective surgery for SRAAA or type IV TAAA using the DPR technique between January 2011 and June 2022. In debranching, using partial side clamping, a multibranch graft was implanted side-to-end into the descending thoracic aorta. The left renal artery was anastomosed end-to-end to the graft. As needed, the superior mesenteric artery (SMA), the celiac trunk, and the right renal artery could also be anastomosed to the graft. In the perfusion step, cannulas were connected to the last branch of the multibranch graft to perfuse other arteries during aortic cross-clamping. For repair, a tube or bifurcated graft was used for the aortic repair. The branch used as a passive temporary arterial shunt was ligated at the end of the intervention. Clinical, radiological, and biological preoperative and postoperative factors were reviewed using a standardized database. Procedural complications and reinterventions were analyzed, as well as artery patency.
There were 40 patients who underwent DPR technique. The mean patient age was 67 ± 13 years and two were women. Twenty-three patients presented with a SRAAA and 17 with a type IV TAAA. The 30-day and 1-year mortality rates were 2.5% (one patient). Two respiratory complications (5%) and three mesenteric ischemic complications (7%) have been recorded. No patient developed signs of cardiac or spinal cord dysfunction. We did not observe a significant change in postoperative renal function. The celiac trunk, superior mesenteric artery, left renal artery, and right renal artery bypass patency rates at 1 year were 95%, 100%, 90%, and 100%, respectively.
The SRAAA and type IV TAAA repair with DPR technique provides short visceral and renal ischemia times with a low mortality rate. This technique could be an option to consider for visceral and renal protection during open surgical repair.
由于术中内脏和肾脏缺血，开放性手术修复肾上腹主动脉瘤（SRAAA）和 IV 型胸腹主动脉瘤（TAAA）仍然是一项具有挑战性的手术。我们报告了一种新的三步技术，称为去分支、灌注、重建（DPR），使用去分支和被动动脉分流来减少这些缺血性并发症。本研究的主要目的是评估与 DPR 技术相关的 30 天和 1 年死亡率。次要目的是评估对肾功能和修复动脉的原发性通畅率的影响。
这项回顾性研究纳入了 2011 年 1 月至 2022 年 6 月期间使用 DPR 技术择期手术治疗 SRAAA 或 IV 型 TAAA 的所有连续患者。在去分支过程中，采用部分侧夹，将多分支移植物端侧吻合到降主动脉。左肾动脉端端吻合到移植物上。根据需要，也可以将肠系膜上动脉（SMA）、腹腔干和右肾动脉吻合到移植物上。在灌注步骤中，在主动脉阻断期间，将导管连接到多分支移植物的最后一个分支上以灌注其他动脉。对于修复，使用管状或分叉移植物进行主动脉修复。作为临时动脉分流的分支在介入结束时结扎。使用标准化数据库回顾术前和术后的临床、放射学和生物学因素。分析了手术并发症和再干预以及动脉通畅率。
共有 40 例患者接受了 DPR 技术。患者平均年龄为 67 ± 13 岁，其中 2 例为女性。23 例患者为 SRAAA，17 例患者为 IV 型 TAAA。30 天和 1 年死亡率分别为 2.5%（1 例）。记录到 2 例呼吸并发症（5%）和 3 例肠系膜缺血并发症（7%）。无患者出现心脏或脊髓功能障碍的迹象。我们没有观察到术后肾功能的显著变化。1 年后腹腔干、肠系膜上动脉、左肾动脉和右肾动脉旁路通畅率分别为 95%、100%、90%和 100%。
使用 DPR 技术修复 SRAAA 和 IV 型 TAAA 可减少内脏和肾脏缺血时间，死亡率低。该技术可能是开放性手术修复过程中保护内脏和肾脏的一种选择。
