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Published on: March 28, 2025
Clinical effect of endovascular repair of complex aortic lesions using optimized Octopus surgery
Yanfeng Sun1, Yang Zhang1, Xiwei Sun1
1Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China.
Insights
The Octopus technique offers a viable solution for complex aortic lesions when other methods are unavailable. This study shows promising short-term results for visceral artery reconstruction, though challenges remain.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Disease
Background:
- Complex aortic lesions, particularly those involving visceral arteries, present significant treatment challenges.
- Current advanced endovascular techniques may not be universally accessible or suitable for all cases.
Purpose of the Study:
- To evaluate the safety and short-term efficacy of the Octopus technique for endovascular repair of complex aortic lesions.
- To analyze outcomes of visceral artery reconstruction using the Octopus technique in a single center.
Main Methods:
- Retrospective analysis of six patients undergoing optimized Octopus surgery between August 2020 and February 2022.
- Evaluation of surgical schemes, operative parameters, complications, and follow-up data.
Main Results:
- All six patients achieved technical success, with 100% visceral artery reconstruction and patency at follow-up.
- Minor complications included gutter endoleaks and transient renal function impairment; two perioperative deaths occurred.
- No cases of intestinal or spinal cord ischemia were observed; long-term follow-up showed no stent-related issues.
Conclusions:
- The Octopus technique is a feasible option for complex aortic lesions, especially when fenestrated/branched grafts are not available.
- While demonstrating potential, the technique requires careful consideration of its operational complexity, associated risks, and long-term outcomes.
- Continued optimization and research into the Octopus technique are warranted for complex aortic disease management.
Abstract:
Objective: Complex aortic lesions, especially those involving branches of the visceral artery, remain a challenge to treat. A single-center study using the Octopus technique to evaluate the safety and short-term effects of endovascular repair of complex aortic lesions was reported and documented. Methods: The data of six cases who underwent optimized Octopus surgery in our center from August 2020 to February 2022 were analyzed retrospectively. The choice of operation scheme, operation time, operation complications, and follow-up data were analyzed among them. Results: The average age of the six patients undergoing optimized Octopus surgery was 55.1 ± 17.2 years. Two cases were diagnosed as pararenal aortic aneurysms; four cases were aortic dissection involving the visceral artery. All cases achieved technical success; all visceral arteries were reconstructed as planned. A total of 17 visceral arteries were planned to be reconstructed; five celiac arteries were embolized. Three cases of gutter endoleak were found during the operation without embolization but with follow-up observation. There were two cases of slight damage to renal function and two cases of perioperative death. Other complications, such as intestinal ischemia and spinal cord ischemia, did not occur. Follow-up ranged from 6 months to 30 months. One patient died of gastrointestinal bleeding 6 months after the operation. At the 6 months follow-up, computed tomographic angiography showed that all internal leaks had disappeared. The patency rate of the visceral artery was 100%, and no complications, such as stent displacement and occlusion, occurred during the follow-up period. Conclusion: With fenestrated and branched stent grafts technology not widely available, and off label use not a viable option, Octopus technology for treating complex aortic lesions should be considered. The Octopus technique is an up-and-coming surgical method, but we should recognize its operation difficulty, operation-related complications, and long-term prognosis. We should pay attention to and continue to optimize Octopus technology.
