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OBJECTIVES:There are a variety of techniques to manage aneurysmal disease involving the visceral and renal aortic segments. Debranching remains a useful technique. This can though be a time consuming operation depending on patient anatomy and number of vessels debranched, as well as fraught with high rates of renal failure.
METHODS: The Gore Hybrid Graft allows for a sutureless rapid anastomosis and can aid in difficult to access vessels and decrease renal ischemia times.
RESULTS: Two patients with Marfan’s syndrome who developed thoracoabdominal aortic aneurysms were treated with Gore Hybrid Grafts for rapid renal bypass as part of the abdominal debranching. Both patients had previous interventions to their thoracic aorta and had developed progressive aneurysmal degeneration of their abdominal aorta. The patients were treated with an aortobiiliac bypass, TEVAR and visceral artery debranching. In both cases, Gore Hybrid Grafts were used to bypass from the iliac limb to both renal arteries. In the second case, with refined technique, total renal ischemia time was only 7 minutes. Patient 1 additionally underwent thoracic aortic debranching during the same hospital stay. Both patients tolerated the procedures well.
At 36 month (Patient 1) and 30 month (Patient 2) follow-up, all viceral and renal arteries remain patent, with preserved renal function and no abdominal symptoms.
CONCLUSIONS:We believe that the use of the Gore Hybrid Graft can aid in repair of complex aortic pathology and may reduce organ ischemia time. In Marfan’s patients where patch aneurysm is a well-established issue, this debranching technique effectively eliminates that obstacle.