Aortic Debranching Implantation Technique
PERFORMANCE through innovation
Case Example Steps of Renovisceral Debranching for
Type IV TAAA using the GORE® Hybrid Vascular Graft
Huey B. McDaniel, MD, St. Dominic-Jackson Memorial Hospital, Jackson, Mississippi, US
4
1
The completed branched graft is ready
for a sutured proximal anastomosis with
deployable nitinol reinforced section distals
for each visceral vessel.
The abdominal aorta and visceral
branches are exposed via a retroperitoneal
technique. Vessel loops are placed around
the visceral vessels.
5
2
A branched device with multiple GORE®
Hybrid Device is constructed. The
appropriately sized nitinol reinforced
sections (5–20% oversized) are chosen for
each branch artery.
A conduit for the deployment of the
endoprosthesis is prepared and sutured to
the healthy aorta.
6
3
The branched GORE® Hybrid Device is
compared to the patient anatomy in situ to
assist with graft geometry and lengths.
The base of the GORE® Hybrid Device
branched construct is sutured to the
healthy aorta. A-traumatic clamps are
placed on each of the vascular graft
branches, and the aorta is unclamped.
7
10
After deployment of each nitinol reinforced
section, each vascular graft branch is
unclamped to immediately restore blood
flow to the visceral organs. Flow is confirmed
with doppler ultrasound.
Each vascular graft clamp is released briefly
to remove air from the graft and to confirm
vigorous blood flow through each branch.
8
11
For each visceral artery, the origin of the
artery is ligated and the artery is either
transected or an arteriotomy is created.
At least 2.5 cm of the nitinol reinforced
section of the GORE® Hybrid Device is
introduced into the artery. Judgment is used
to preserve important branch arteries.
9
Two longitudinal stay sutures are placed
through the artery wall and the nitinol
reinforced section for each visceral vessel.
12
While stabilizing the nitinol reinforced
section, the deployment line is pulled
parallel to the vascular graft section.
An endoprosthesis is placed through the
conduit to cover the aneurysm.
Tips for Success
• Limit organ ischemic time by suturing the proximal
end / inflow of the branched GORE® Hybrid Device first.
• To minimize exposure, the nitinol reinforced section can be
introduced over the wire into the aortic branch artery.
• Leave enough redundancy in the vascular graft branches to
minimize the potential for kinking.
• Compare the branched GORE® Hybrid Device to the patient
anatomy in situ to assist with graft geometry and lengths.
• After suturing the proximal anastomosis, bleed each vascular
graft branch to minimize the introduction of air and to confirm
blood flow through each vascular graft branch.
• Insert at least 2.5 cm of the nitinol reinforced section into the
artery using judgment to preserve important branch arteries.
• Oversize the nitinol reinforced section for each branch artery
by 5–20%.
• Place two longitudinal stay sutures through the artery wall and
the nitinol reinforced section.
W. L. Gore & Associates, Inc.
Flagstaff, AZ 86004
+65.67332882 (Asia Pacific)
00800.6334.4673 (Europe)
800.437.8181 (United States)
928.779.2771 (United States)
goremedical.com
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GORE®, PERFORMANCE THROUGH INNOVATION, and designs are trademarks of W. L. Gore & Associates.
© 2012 W. L. Gore & Associates, Inc. AQ0775-EN1 MARCH 2012