title: Evaluation of the optimal visceral branch configuration in open thoracoabdominal aortic repair by computed tomography.
abstract: BACKGROUND
  In thoracoabdominal aneurysm (TAAA) repair, our technical modification of visceral reconstruction using longer cut pre-sewn side branches has provided good surgical outcomes. Here, we assessed the long-term durability and patency of revascularized branches using computed tomography (CT) to confirm the validity of our approach.
  
  
  METHODS
  Early and late CT evaluations were performed in 11 TAAA patients (males: 5; mean age: 60.6 years) using the Coselli graft to evaluate the position of main graft and the diverging pattern and patency of side branches. Seven of 11 were sutured in an extra-anatomical fashion using longer cut side branches.
  
  
  RESULTS
  In Anatomical (n = 4) and Extra-anatomical (n = 7) groups, the early patency of side branches was not significantly different. Although the late patency of right renal artery (RA) was 100% in both groups, the one of left RA was 60% in Extra-anatomical, while 100% in Anatomical. Furthermore, the main graft in Extra-anatomical was significantly posterior and leftward to the spine with left RA side branch diverging at an acute angle.
  
  
  CONCLUSIONS
  When a pre-sewn branched graft designed for TAAA is used, the graft should be sutured in a fashion similar to normal patient anatomy to minimize the possibility of kinking of RA side branch for the patency.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Saga, Saga, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Kamohara
authors.forename: Kojiro
authors.initials: K
authors.lastname: Furukawa
authors.forename: Manabu
authors.initials: M
authors.lastname: Itoh
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Morokuma
authors.forename: Hideya
authors.initials: H
authors.lastname: Tanaka
authors.forename: Nagi
authors.initials: N
authors.lastname: Hayashi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Morita
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency