Presentation

Clampless Anastomosis on the Supraceliac Aorta for Aorto-mesenteric Bypass

In this presentation, a hybrid technique of clampless anastomosis on the supraceliac aorta for aorto-mesenteric bypass is described.

Comments

    Dr. W. Michael Park
    October 1, 2018

    Thank you for this wonderful presentation with excellent result. Was there any options for an iliac artery to mesenteric artery bypass? Do you prefer this if there were anilin option?

    Dr Raphael Coscas
    October 2, 2018

    Thank you for the question. Unfortunately, the whole iliacs were full of ballon-expandable stents. If the iliacs are healthy, we sure go on a retrograde bypass option. This was not possible in this case.

    Dr. Theodosios Bisdas
    October 2, 2018

    Great contribution Raphael. Did I understand your technique right? Are you puncturing the graft twice or only at the distal part? How are you puncturing the aortic wall in order to introduce your wire?
    My second question: can you provide us the diameters of the graft and the BeGraft? Do you perform any predilatation of the aorta at the level of the anastomosis?

    Dr Raphael Coscas
    October 3, 2018

    Thanks for the question Theo! The graft is just punctured at its distal part. Then the needle is advanced down to the center of the expected anastomosis. This is done using manual feelings. The surgical graft was 7 mm and the stent was 8 mm. Predilatation is not necessary.

    MD Michel Bosiers
    October 3, 2018

    Great technique, thanks for sharing! Has this become your standard technique, and do you have any follow up data, or is this a unique case?

    Dr Raphael Coscas
    October 5, 2018

    Thank you for your comment,
    This is not our standard technique since it leave a stent across the anastomosis and some uncertainties remain about the durability. However, we performed our first case 3 years ago (on the infrarenal aorta) and the patient is still doing well with a patent stent and bypass.

    MD Yukun Li
    October 5, 2018

    Thank you very much for sharing us this innovative case, Dr. Coscas. We have a similar patient in China. She is just 50 years old( heavy smoker). Do you recommend this procedure on her? Is there any follow up Data relating to patency?

    Dr Raphael Coscas
    October 5, 2018

    It could be an option. I would keep in mind that a patient with such lesions has probably a decreased life expectancy. We performed this technique on 5 patients so far without failure or complication. The first one was performed 3 years ago and is still patent without restenosis.

    Dr Praveen Balraj
    May 28, 2019

    Great case planning ! Good result indeed!

    What are the intro-op complications and pitfalls can we expect when doing this for the first time? Bail out techniques etc. plz

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