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How-to-do-it

Novel technique for reimplantation of intercostal arteries using tailored patch graft

Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization, Osaka Rosai Hospital, Nagasone-cho, Kita-ku, Sakai, Osaka, Japan

Received 27 January 2008; received in revised form 29 April 2008; accepted 6 May 2008.

^_* Corresponding author. Tel.: +81 72 252 3561; fax: +81 72 255 3349. (Email: ktodaoch{at}yahoo.com).

We developed a simple and secure technique for reimplantation of the intercostal arteries (ICAs) using a patch graft during thoracoabdominal aneurysm repair. With our procedure, a sidearm branch with its base is tailored from a 24 mm one-branch Dacron graft, and then sutured as a patch graft to the trimmed wall of the descending aorta to cover the ICA orifices between Th9 and Th12. The proximal end of the patch graft is then anastomosed to the main tube graft, while the graft is perfused. With this technique, the entire suture lines are clearly visible and hemostasis is secured without difficulty. We used this technique in 6 patients, in whom 2.3 ± 0.8 pairs of ICAs were reimplanted. The time required for reimplantation of the ICAs was 14 ± 6 min and none of 6 patients developed paraplegia. Our results indicate that this novel technique is a simple method to obtain secure hemostasis under direct vision, which may contribute to reduce the risk of paraplegia during thoracoabdominal aneurysm repair.

Key Words: Aortic operation • Spinal cord • Aneurysm