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Published on: May 14, 2013
Hybrid Clampless Anastomosis in Antegrade Aorto-Superior Mesenteric Artery Bypass
Elisabetta Tanda1, Sara Zappadu1, Gabriele De Donno1
1Unit of Vascular Surgery, "Cliniche San Pietro" Hospital, AOU Sassari, Sassari, Italy.
Insights
This study presents a novel hybrid clampless bypass technique for severe aorto-iliac calcifications, offering a safe solution for complex mesenteric ischemia cases. The procedure demonstrated successful graft patency in all patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Surgical Innovation
Background:
- Severe aorto-iliac calcifications pose significant challenges for traditional bypass surgery and endovascular approaches.
- Chronic mesenteric ischemia with ostial celiac trunk and superior mesenteric artery (SMA) occlusion requires innovative treatment strategies.
- Preoperative imaging revealed complex anatomy including coral reef aorta and severe iliac calcifications.
Purpose of the Study:
- To describe the experience and outcomes of a hybrid clampless aorto-mesenteric bypass in patients with severe aorto-iliac calcifications.
- To evaluate the safety and efficacy of a novel clampless anastomosis technique on the supraceliac aorta.
Main Methods:
- A hybrid clampless side-to-end media-adventitial anastomosis was created on the supraceliac aorta using a Dacron graft.
- The anastomosis site was stabilized with balloon-expandable covered stenting after needle puncture and wire insertion.
- The graft was then tunneled to the SMA for an end-to-side anastomosis.
Main Results:
- The hybrid clampless procedure was successfully performed via laparotomy in three patients.
- All procedures were completed without aortic clamping or arteriotomy.
- Postoperative courses were uneventful, with prompt patient discharge and complete graft patency observed during follow-up (up to 4 years).
Conclusions:
- The hybrid clampless anastomosis is a safe and effective technique for treating chronic mesenteric ischemia in the setting of severe aorto-iliac calcifications.
- This innovative approach offers a viable alternative when standard surgical or endovascular methods are high-risk or unsuccessful.
Background:
Bypass surgery in severe aorto-iliac calcifications is a complex procedure. Aortic clamping can be highly risky and endovascular approach can be unsuccessful. We report our experience describing three cases of chronic mesenteric ischemia. In all three cases the preoperative computed tomography angiography revealed an ostial occlusion of the celiac trunk and of the superior mesenteric artery (SMA), a coral reef abdominal aorta, and severe calcification of the iliac arteries. An antegrade aorto-mesenteric bypass using a hybrid clampless anastomosis on the supraceliac aorta was performed.
Results:
The procedures were performed via laparotomy. We carried out the exposure of the anterior supraceliac aorta limited to the zone without major calcifications; then we performed a side-to-end media-adventitial anastomosis between the supraceliac aorta and a Dacron graft 7 mm without any arteriotomy or clamping. The proximal graft and the aortic anastomosis site were punctured using a 18 G needle. An introducer was then positioned over a wire through the prosthetic graft and pushed into the aorta. Balloon expandable covered stenting to open and stabilize the anastomosis site was performed. Finally, the graft was tunneled to the SMA, and an end-to-side anastomosis was performed. The postoperative courses were uneventful, and the patients were promptly discharged. The follow-up, which in the first case is 4 years, showed the complete patency of the graft in each of the cases treated.
Conclusions:
The hybrid clampless anastomosis appears to be safe and useful in cases of severe aortic calcification.
