title: Onlay patch for complete intercostal artery preservation during thoracic and thoracoabdominal aortic aneurysm repair.
abstract: BACKGROUND
  Replacement of the thoracic aorta is associated with a potential for interruption of the blood supply to the spinal cord leading to paralysis. Techniques have been proposed to ameliorate this risk, including reimplantation of the intercostal arteries. We present a technique to simplify this approach.
  
  
  METHODS
  In patients with extensive aneurysmal disease, a standard approach to the thoracic aorta via a left thoracotomy is performed. The patient is placed on full cardiopulmonary bypass with moderate hypothermia. The proximal anastomosis is performed unclamped with circulatory arrest. After completing the proximal and distal anastomosis separately, an onlay patch of Dacron is created and placed along the entire back wall of the aorta to cover all of the intercostal arteries. A side-to-side anastomosis between the patch and the distal graft is then performed and subsequently the anastomosis tested by retrograde flow.
  
  
  RESULTS
  The technique allows direct inspection of all suture lines, tested to an adequate pressure, so that postoperative bleeding is minimal.
  
  
  CONCLUSIONS
  Techniques to lessen the risk of paraplegia associated with aortic surgery include reimplantation of the intercostal arteries. This technique allows each suture line to be tested and easily visually inspected prior to closure of the chest.
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298-0068, USA. adeanda@vcu.edu
authors.forename: Abe
authors.initials: A
authors.lastname: DeAnda
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Philpott
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Kasirajan
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008297:Male