A hybrid clampless technique for aortic anastomoses.

Area of Science:

• Vascular Surgery
• Cardiovascular Interventions
• Surgical Innovation

Background:

• Aortic repairs involving heavy calcifications or thrombus pose high risks with open and endovascular methods.
• Aortic clamping can lead to complications like emboli, rupture, and endovascular technique failure.
• Challenging aortic anatomies necessitate alternative surgical approaches.

Purpose of the Study:

• To describe a novel hybrid technique for performing aortic anastomosis without clamping.
• To provide a safe and reproducible solution for high-risk aortic repair scenarios.
• To address limitations of current open and endovascular aortic repair methods.

Main Methods:

• A limited anterior aortic wall exposure in a healthy segment.
• Adventitial suture of a prosthetic graft without arteriotomy or clamping.
• Guidewire insertion via needle puncture for fluoroscopic positioning.
• Protected covered stenting to open the anastomosis without aortic clamping.
• Standard distal anastomosis to the target artery.

Main Results:

• Successful application of the hybrid technique in 10 consecutive challenging cases.
• Demonstrated sustained patency of the aortic anastomosis.
• The technique proved effective in complex aortic lesions.

Conclusions:

• The described hybrid clampless technique is a valuable alternative for challenging aortic lesions.
• This approach is suitable for patients not amenable to standard open or endovascular treatments.
• It offers a reproducible and safe method for complex aortic anastomosis.