[Reconstruction of radicular arteries in the total replacement of thoracoabdominal aorta]

A technique of reconstructing low intercostal, high lumbar arteries and Adamkiewicz artery is described to prevent paraplegia following operations on the thoracoabdominal aorta. A graft with a side branch is anastomosed proximally and a side branch to the distal thoracic aorta after reinforcement of the stumps under the partial bypass. Applying a clamp on the main graft, flow through the side branch and true lumen of the aneurysm is reestablished and bypass is terminated. The main graft, extended with a Y-graft, is anastomosed to common iliac arteries after proximal suture-ligation to perfuse the lower extremities. Splanchnic arteries are reconstructed according to DeBakey's technique which is followed by trimming of the thoracoabdominal aorta incising longitudinally with a clamp applied on the 1st side branch. Edges of the trimmed aneurysm are sutured to the slit of the graft from the right common iliac artery reconstructing intercostal, lumbar arteries and Adamkiewicz artery from the level of L2 upwards to T4 or more. As a final step, the graft is sutured to the 1st side branch allowing perfusion distally to the right lower extremity and the main graft to the splanchnic arteries and left lower extremity after division of a Y-graft right branch. The technique minimizes ischemic time for reconstruction of the aortic branches and enables complete reconstruction of the radicular arteries.