Hybrid Technique: Reoperative Thoracoabdominal Aneurysm Repair

Physicians are to be congratulated for their successful treatment in such a challenging case. It is definitely not an easy procedure and requires knowledge, skills and expertise. Various de-branching techniques including total abdominal de-branching is an applied option at our institution for selected cases with comorbidity factors. Different than here presented in the video, we prefer an 8mm ring reinforced PTFE graft to provide the inflow for the ease of the anastomosis of a smaller main body (smaller than readiliy available marketed bifurcated dacron grafts) to a relatively less diseased artery, to one of the iliacs or infrarenal aorta. In addition, rather than a quadrifurcated graft created with the combination of 8mm (it is the inflow main body and anastomosis to the SMA and Celiac trunk usually) and 6mm (usually anastomosed to the renal arteries) ringed PTFE grafts, we do not hesitate to separately de-branch renal arteries relying on a kink-free bypass from one of the iliacs or the infrarenal abdominal aorta. As noted in the video, especially the renal arteries are challenging and even simple clamping may lead to dissection or severe damage to these vessels. Once again, congratulations.