Renal and Visceral Sutureless Anastomosis During Thoracoabdominal Aortic Repair

  • Andrea KahlbergEmail author
  • Matteo Bossi
  • Daniele Mascia
  • Enrico Rinaldi
  • Yamume Tshomba
  • Germano Melissano
  • Roberto Chiesa


Perioperative renal failure is still one of the most feared complications of thoracoabdominal aortic aneurysm (TAAA) open repair and represents a strong predictor for early and late mortality. Despite improvements in renal cold protection, a key role for renal function preservation is played by the reduction of ischemic time: this aspect can be obtained by different techniques for renal reconstruction. Moreover, the possibility of vessel damaging and early occlusions must be considered upon deciding the operating technique.

Similar topics must be considered for the visceral vessels, especially for those far away and difficult to expose.

The use of the Gore Hybrid Vascular Graft (GHVG) with distal sutureless anastomosis for the separate reattachment of both renal and visceral vessels during TAAA open repair has proven to be feasible and safe, especially in cases of remote location of the vessel origin or with severe atherosclerotic disease of the ostium.

Supplementary material

Movie 19.1

Video showing Gore Hybrid Vascular Graft (GHVG) deployment during TAAA open repair. The GHVG is gently placed into the artery for 2–3 cm. The stent is released and ballooned after deployment. The cold renal perfusion catheter is then immediately reinserted into the graft. Of note stiches for fixation of GHVG to the renal artery and device. Finally, the proximal anastomosis to the main aortic graft is completed (AVI 189508 kb)


  1. 1.
    Lemaire SA, Jones MM, Conklin LD, Carter SA, Criddell MD, Wang XL, et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49(1):11–9.CrossRefGoogle Scholar
  2. 2.
    Bensley RP, Curran T, Hurks R, Lo RC, Wyers MC, Hamdan AD, et al. Open repair of intact thoracoabdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program. J Vasc Surg. 2013;58:894. Scholar
  3. 3.
    van Kuijk JP, Flu WJ, Chonchol M, Hoeks SE, Winkel TA, Verhagen HJ, et al. Temporary perioperative decline of renal function is an independent predictor for chronic kidney disease. Clin J Am Soc Nephrol. 2010;5(7):1198–204.CrossRefGoogle Scholar
  4. 4.
    Lachat M, Mayer D, Criado FJ, Pfammatter T, Rancic Z, Genoni M, et al. New technique to facilitate renal revascularization with use of telescoping self-expanding stent grafts: VORTEC. Vascular. 2008;16(2):69–72.CrossRefGoogle Scholar
  5. 5.
    Fehrenbacher JW, Corvera JS. Best surgical option for thoracoabdominal aneurysm repair - the open approach. Ann Cardiothorac Surg. 2012;1(3):334–8.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Schepens MA, Heijmen RH, Ranschaert W, Sonker U, Morshuis WJ. Thoracoabdominal aortic aneurysm repair: results of conventional open surgery. Eur J Vasc Endovasc Surg. 2009;37(6):640–5.CrossRefGoogle Scholar
  7. 7.
    Piazza M, Ricotta JJ 2nd. Open surgical repair of thoracoabdominal aortic aneurysms. Ann Vasc Surg. 2012;26(4):600–5.CrossRefGoogle Scholar
  8. 8.
    Panneton JM, Hollier LH. Nondissecting thoracoabdominal aortic aneurysms: part I. Ann Vasc Surg. 1995;9(5):503–14.CrossRefGoogle Scholar
  9. 9.
    Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17(2):357–68; discussion 368–70.CrossRefGoogle Scholar
  10. 10.
    Back MR, Bandyk M, Bradner M, Cuthbertson D, Johnson BL, Shames ML, et al. Critical analysis of outcome determinants affecting repair of intact aneurysms involving the visceral aorta. Ann Vasc Surg. 2005;19(5):648–56.CrossRefGoogle Scholar
  11. 11.
    Dubois L, Durant C, Harrington DM, Forbes TL, Derose G, Harris JR. Technical factors are strongest predictors of postoperative renal dysfunction after open transperitoneal juxtarenal abdominal aortic aneurysm repair. J Vasc Surg. 2013;57(3):648–54.CrossRefGoogle Scholar
  12. 12.
    Crawford ES, Snyder DM, Cho GC, Roehm JO Jr. Progress in treatment of thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries. Ann Surg. 1978;188(3):404–22.CrossRefGoogle Scholar
  13. 13.
    Tshomba Y, Melissano G, Civilini E, Setacci F, Chiesa R. Fate of the visceral aortic patch after thoracoabdominal aortic repair. Eur J Vasc Endovasc Surg. 2005;29(4):383–9.CrossRefGoogle Scholar
  14. 14.
    Tshomba Y, Bertoglio L, Marone EM, Melissano G, Chiesa R. Visceral aortic patch aneurysm after thoracoabdominal aortic repair: conventional vs hybrid treatment. J Vasc Surg. 2008;48(5):1083–91.CrossRefGoogle Scholar
  15. 15.
    Kulik A, Castner CF, Kouchoukos NT. Patency and durability of presewn multiple branched graft for thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2010;51(6):1367–72.CrossRefGoogle Scholar
  16. 16.
    Black JH 3rd. Technique for repair of suprarenal and thoracoabdominal aortic aneurysms. J Vasc Surg. 2009;50(4):936–41.CrossRefGoogle Scholar
  17. 17.
    Clouse WD, Marone LK, Davison JK, Dorer DJ, Brewster DC, LaMuraglia GM, et al. Late aortic and graft-related events after thoracoabdominal aneurysm repair. J Vasc Surg. 2003;37(2):254–61.CrossRefGoogle Scholar
  18. 18.
    Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients. J Vasc Surg. 1992;16:378–90.CrossRefGoogle Scholar
  19. 19.
    Clair DG, Belkin M, Whittemore AD, Mannick JA, Donaldson MC. Safety and efficacy of transaortic renal endarterectomy as an adjunct to aortic surgery. J Vasc Surg. 1995;21:926–34.CrossRefGoogle Scholar
  20. 20.
    Chiesa R, Melissano G, Civilini E, Bertoglio L, Rinaldi E, Marone EM, et al. Video-atlas of open thoracoabdominal aortic aneurysm repair. Ann Cardiothorac Surg. 2012;1(3):398–403.PubMedPubMedCentralGoogle Scholar
  21. 21.
    LeMaire SA, Jamison AL, Carter SA, Wen S, Alankar S, Coselli JS. Deployment of balloon expandable stents during open repair of thoracoabdominal aortic aneurysms: a new strategy for managing renal and mesenteric artery lesions. Eur J Cardiothorac Surg. 2004;26(3):599–607.CrossRefGoogle Scholar
  22. 22.
    Patel R, Conrad MF, Paruchuri V, Kwolek CJ, Cambria RP. Balloon expandable stents facilitate right renal artery reconstruction during complex open aortic aneurysm repair. J Vasc Surg. 2010;51(2):310–5.CrossRefGoogle Scholar
  23. 23.
    Donas KP, Lachat M, Rancic Z, Oberkofler C, Pfammatter T, Guber I, et al. Early and midterm outcome of a novel technique to simplify the hybrid procedures in the treatment of thoracoabdominal and pararenal aortic aneurysms. J Vasc Surg. 2009;50(6):1280–4.CrossRefGoogle Scholar
  24. 24.
    Donas KP, Rancic Z, Lachat M, Pfammatter T, Frauenfelder T, Veith FJ, et al. Novel sutureless telescoping anastomosis revascularization technique of supra-aortic vessels to simplify combined open endovascular procedures in the treatment of aortic arch pathologies. J Vasc Surg. 2010;51(4):836–41.CrossRefGoogle Scholar
  25. 25.
    Bonvini S, Ricotta JJ, Piazza M, Ferretto L, Grego F. ViPS technique as a novel concept for a sutureless vascular anastomosis. J Vasc Surg. 2011;54(3):889–92.CrossRefGoogle Scholar
  26. 26.
    Greenberg G, Szendro G, Mayzler O, Ginzburg V, Leytzin A. Use of ViaBahn open revascularisation technique for above-knee femoro-popliteal anastomosis: a technical note. Eur J Vasc Endovasc Surg. 2011;42(2):202–5.CrossRefGoogle Scholar
  27. 27.
    Levack MM, Bavaria JE, Gorman RC, Gorman JH 3rd, Ryan LP. Rapid aortic arch debranching using the Gore hybrid vascular graft. Ann Thorac Surg. 2013;95(6):e163–5.CrossRefGoogle Scholar
  28. 28.
    Nigro G, Gatta E, Pagliariccio G, Grilli C, Carbonari L. Use of the Gore Hybrid Vascular Graft in a challenging high-lying extracranial carotid artery aneurysm. J Vasc Surg. 2014. Scholar
  29. 29.
    Bornak A, Goldstein LJ, Rey J, Medina A, Yang JK, Velazquez OC, et al. Aortic aneurysmal repair with surtureless visceral revascularization using novel hybrid vascular graft and a gradual funneling technique. Vasc Endovasc Surg. 2012;46(3):258–61.CrossRefGoogle Scholar
  30. 30.
    W. L. Gores & Associates. Instructions for use for Gore Hybrid Vascular Graft.
  31. 31.
    Tshomba Y, Kahlberg A, Melissano G, Coppi G, Marone E, Ferrari D, et al. Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2014;59:623–33.CrossRefGoogle Scholar
  32. 32.
    Kashyap VS, Cambria RP, Davison JK, L’Italien GJ. Renal failure after thoracoabdominal aortic surgery. J Vasc Surg. 1997;26(6):949–55; discussion 955–7.CrossRefGoogle Scholar
  33. 33.
    Saha SP, Muluk S, Schenk W 3rd, Dennis JW, Ploder B, Grigorian A, Presch I, Goppelt A. A prospective randomized study comparing fibrin sealant to manual compression for the treatment of anastomotic suture-hole bleeding in expanded polytetrafluoroethylene grafts. J Vasc Surg. 2012;56(1):134–41.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andrea Kahlberg
    • 1
    Email author
  • Matteo Bossi
    • 1
  • Daniele Mascia
    • 1
  • Enrico Rinaldi
    • 1
  • Yamume Tshomba
    • 2
    • 3
  • Germano Melissano
    • 1
  • Roberto Chiesa
    • 4
  1. 1.Vascular SurgeryVita-Salute University School of Medicine, San Raffaele Scientific InstituteMilanItaly
  2. 2.Unit of Vascular SurgeryFondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro CuoreRomeItaly
  3. 3.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly
  4. 4.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly

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