Experimental model for sutureless proximal anastomosis by the viabahn open revascularization technique (VORTEC)

Freire, Lucas Marcelo Dias; Gobbi, Giuliana Biasi; Fabbro, Inácio Maria Dal; Menezes, Fábio Hüsemann

Abstract

Introduction:

In the treatment of complex aneurysms, debranching is an extra-anatomical revascularization of visceral arteries followed by endograft coverage of the thoracoabdominal aorta. It eliminates the need for a thoracotomy and aortic clamping, but requires the performance of several technically demanding visceral anastomosis. In 2008, Lachat described visceral revascularization with the use of a sutureless distal anastomosis, performed by the telescoping of an endograft in the visceral branch, named VORTEC (Viabahn Open Revascularization TEChnique).

Objective:

An experimental model was created to test the feasibility and short term results of performing a telescoped proximal anastomosis to the abdominal aorta.

Methods:

Swine model. The abdominal aorta was dissected and ligated between the renal arteries and the iliac vessels. Three centimeters bellow the renal arteries a Viabahn endograft was telescoped for 2 cm into the proximal aorta. The other extremity was conventionally anastomosed to the distal aorta. Patency, sealing and tensile strength of the anastomosis were tested.

Results:

Time for performing the telescoped anastomosis was shorter (5.4±2.8 min versus 10.3±3.4 min, P<0.05). All grafts were patent and both types of anastomosis presented no bleeding. Immediate tensile strength showed a higher strength of the conventional suture (22.7 x 14.3 N, P<0.09). After 30 days there was no pseudo-aneurysms and the strength of the conventional and VORTEC anastomosis were similar (37.3 x 40.8 N, respectively, P=0.17).

Conclusion:

Telescoped proximal anastomosis by the technique of VORTEC is feasible. After 30 days the tensile strength of the both anastomosis were similar.

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