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Branch graft patency after open repair of thoracoabdominal aortic aneurysms
Nicholas T Kouchoukos1, Alexander Kulik2, Catherine Castner1
1Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC HealthCare, St Louis, Mo.
Insights
Long-term branch graft patency after open thoracoabdominal aortic aneurysm repair is excellent. This study shows high success rates for visceral and renal artery reconstruction, offering a benchmark for future techniques.
Area of Science:
- Vascular Surgery
- Aortic Aneurysm Repair
- Graft Patency
Background:
- The long-term function of branch grafts in open thoracoabdominal aortic aneurysm (TAAA) repair remains incompletely understood.
- Assessing graft patency is crucial for evaluating surgical techniques in complex aortic reconstructions.
Purpose of the Study:
- To evaluate the long-term patency of branch grafts used to reconstruct visceral and renal arteries during open TAAA repair.
- To establish a benchmark for graft performance in this patient population.
Main Methods:
- Retrospective analysis of 99 patients undergoing open TAAA repair with 298 branch grafts.
- Serial postoperative imaging studies (angiography) with a mean follow-up of 40.4 months (up to 159 months).
- Assessment of graft patency to the celiac, superior mesenteric, and renal arteries.
Main Results:
- Overall freedom from occlusion at 1, 5, and 10 years was 98%, 97%, and 93%, respectively.
- Nine graft occlusions occurred in 6 patients; most were asymptomatic or managed conservatively.
- One patient experienced intestinal ischemia, and another required dialysis due to renal artery graft occlusion.
Conclusions:
- Branch grafts for open TAAA repair demonstrate favorable long-term patency rates.
- These findings provide a benchmark for comparing alternative visceral and renal artery revascularization techniques.
- The study highlights the durability of branch grafts in complex aortic surgery.
Objectives:
The long-term function of branch grafts to the visceral and renal arteries during open thoracoabdominal aortic aneurysm repair is unknown. We assessed the patency of single and multiple branch grafts with postoperative imaging studies in patients followed for up to 13 years.
Methods:
A total of 99 of 130 patients undergoing open thoracoabdominal aortic aneurysm repair who received a total of 298 branch grafts to the celiac, superior mesenteric, and renal arteries were evaluated with serial imaging studies at 6- to 12-month intervals. The mean duration of angiographic follow-up was 40.4 months and extended to 159 months. Thirty-three patients receiving 74 grafts were followed for more than 5 years, and 7 patents receiving 22 grafts were followed for more than 10 years. Eighty-four grafts were grafted to the celiac artery, 73 grafts were grafted to the superior mesenteric artery, 71 grafts were grafted to the left renal artery, and 70 grafts were grafted to the right renal artery.
Results:
Nine graft occlusions occurred in 6 patients. One of these patients died of intestinal ischemia after occlusion of the celiac and superior mesenteric artery grafts, and 1 patient developed occlusion of both renal artery grafts and remains on dialysis. Five graft occlusions in the other 4 patients were asymptomatic, and no interventions were required. One additional patient developed significant stenosis of the celiac, superior mesenteric, and right renal arteries and underwent successful percutaneous angioplasty. No other patient required intervention. Freedom from occlusion of the 298 grafts at 1, 5, and 10 years is 98%, 97%, and 93%, respectively.
Conclusions:
This represents the largest series of patients with branch grafts for open thoracoabdominal aortic aneurysm repair with extended angiographic follow-up. The favorable long-term graft patency rates represent a benchmark against which methods for establishing flow to the visceral and renal arteries using alternative techniques can be compared.
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