[Debranch Thoracic Endovascular Aortic Therapy for Extending Aneurysms]

Area of Science:

• Vascular Surgery
• Endovascular Aortic Repair
• Thoracic Endovascular Aortic Repair (TEVAR)

Background:

• Reconstructing branches is essential for endovascular aortic repair of arch or thoracoabdominal pathology.
• Current limitations in Japan necessitate alternative techniques for complex aortic diseases.
• Hybrid approaches are vital when standard graft replacement is not feasible.

Purpose of the Study:

• To describe the
• in situ fenestration with squid capture technique
• for endovascular aortic repair.
• To present a hybrid technique for thoracoabdominal aneurysms using bypass grafts.
• To highlight the safety and efficacy of these methods in complex aortic pathologies.

Main Methods:

• "In situ fenestration with squid capture technique" involves creating fenestrations in a stent graft and capturing branches.
• Percutaneous cardiopulmonary bypass maintains cerebral circulation during the procedure.
• Hybrid TEVAR for thoracoabdominal aneurysms includes creating bypasses between iliac/femoral arteries and visceral arteries.

Main Results:

• The "in situ fenestration with squid capture technique" avoids the gutter leak risk associated with the chimney technique.
• Hybrid TEVAR with retroperitoneal anastomosis allows for single-plane procedures.
• No paraplegia occurred in 50 cases, except for one emergency TEVAR under hypotension.

Conclusions:

• The "in situ fenestration with squid capture technique" is a safe and effective method for branch reconstruction in endovascular aortic repair.
• Hybrid TEVAR provides a viable solution for thoracoabdominal aneurysms when standard grafts are not an option.
• Careful hemodynamic management is crucial to prevent complications like paraplegia during hybrid procedures.