Open aortic repair up to previous abdominal aortic surgery
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Updated: Apr 29, 2026
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Antoine Monnot1, Martin Rouer1, Marie M Dusseaux2
1Department of Vascular Surgery, Rouen University Hospital, Rouen, France.
Insights
Direct open repair of thoracoabdominal aortic aneurysms after prior abdominal aortic surgery is safe. This approach, involving sequential aortic reconstruction with visceral bypasses, minimizes ischemic damage and shows no mortality or paraplegia in experienced hands.
Area of Science:
- Vascular Surgery
- Aortic Aneurysm Repair
- Surgical Outcomes
Background:
- Previous abdominal aortic surgery presents challenges for thoracoabdominal aortic aneurysm (TAAA) repair.
- Evaluating the safety of direct open repair in these complex cases is crucial.
Purpose of the Study:
- To assess the safety and efficacy of direct open repair for thoracoabdominal aortic aneurysms in patients with a history of abdominal aortic surgery.
Main Methods:
- A cohort of 10 patients with TAAAs underwent open repair between 2006 and 2012.
- Techniques included sequential aortic reconstruction with bypasses to visceral and renal arteries, and revascularization of critical intercostal arteries.
- Specific strategies were employed for Crawford type III and IV aneurysms.
Main Results:
- Zero mortality and zero paraplegia rates were observed.
- Pulmonary complications occurred in 5 patients; renal function returned to baseline.
- Mean follow-up was 35 months with no late deaths.
Conclusions:
- Direct open redo aortic surgery for TAAAs is a safe option.
- Sequential reconstruction with visceral bypasses effectively mitigates ischemic damage from high aortic cross-clamping.
Background:
To determine whether direct open repair of thoracoabdominal aortic aneurysms after previous abdominal aortic surgery is a safe option.
Methods:
Ten patients were operated between January 2006 and January 2012. Mean age was 70 years (62-78 years). Four aneurysms (Crawford type III) were treated by firstly performed bypasses from the upper thoracic aorta to the celiac trunk, the superior mesenteric artery, and the left renal artery. Secondly performed aortic repair included revascularization of intercostal arteries identified as critical for spinal cord and the right renal artery. Similarly, the 6 aneurysms (Crawford type IV) were treated by firstly performed bypass from the upper thoracic aorta to the left renal artery before aortic repair.
Results:
The overall mortality and paraplegia rates were nil. The maximal creatinin sera variation was 48 ± 16% with return to the baseline level before discharge. Five patients presented with pulmonary complications. The duration of stay was 9.3 days (2-29) in the intensive care unit and 24 days (10-40) in the surgical unit. The mean follow-up was 35 months. No patient died during the follow-up.
Conclusions:
In our experience, open redo aortic surgery appears to be safe. The main relevant point is the sequential reconstruction of the aorta including bypasses of the visceral branches that lowered the visceral ischemic damage because of high level aortic cross-clamping.
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