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.