[Technique to Reinforce Double-barreled Distal Aortic Anastomosis in the Repair of Aortic Dissection]

We describe a technique to reinforce a double-barreled aortic anastomosis in the repair of chronic aortic dissection. After distal aortic resection was carried out, an intimal flap was incised lineally 1 cm in width along with its margin. This intimal band was reapproximated to the adventitia which supported the false lumen. The wedge-shaped excision was made on the residual intimal flap to maintain blood flow to both the true and false lumens. Two felt strips were circumferentially placed inside and outside of the aortic edge, and the layers were sandwiched together with monofilament sutures. Finally, the prosthetic graft was anastomosed to the reinforced aortic stump with continuous suture. If the length of the intimal edge was shorter than that of the dissected adventitia, the intima was incised in a long, triangular shape from its base to form 2 ligulate flaps. The flaps were then slid together and attached to the corresponding adventitia, and the aortic stump was reinforced using the sandwich technique. This technique may be an effective and safe method for reinforcement of a double-barreled aortic anastomosis in the repair of chronic aortic dissection.