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  • Title: Transaortic modification of the Viabahn open revascularization technique (VORTEC) to facilitate renal artery revascularization in a hybrid EVAR procedure.
    Author: Tsai MT, Tseng CC, Kan CD.
    Journal: J Endovasc Ther; 2013 Oct; 20(5):647-51. PubMed ID: 24093316.
    Abstract:
    PURPOSE: To present a modification of the Viabahn open revascularization technique (VORTEC) to facilitate right renal artery (RRA) revascularization via a limited thoracotomy and transaortic sheath during endovascular aneurysm repair (EVAR). CASE REPORT: A 51-year-old man with uncontrolled hypertension and limited respiratory reserve presented with a pararenal abdominal aortic aneurysm (AAA) measuring ∼15×8.5×8 cm extending into the iliac arteries. Via a limited low thoracoabdominal incision and retroperitoneal approach, 3 of the renovisceral branches were exposed, but there was difficulty in approaching the RRA. A handmade 4-branched polytetrafluoroethylene graft (PTFE) was anastomosed to the descending thoracic aorta, and the 3 exposed renovisceral branches were bypassed sequentially. A modification of the VORTEC with a transaortic approach to revascularize the RRA was successful; a 7-mm×10-cm Viabahn stent-graft was advanced into the RRA and deployed into the RRA limb of the PTFE graft. The Viabahn-PTFE graft junction was fixed with interrupted suture, and its transaortic portion was dilated with a 7-mm balloon. EVAR was then accomplished with a 28.5-mm Excluder stent-graft. The final angiogram documented patent bypass grafts and no endoleak. Follow-up imaging showed a satisfactory stent-graft and patent PTFE graft without undue kinking of the Viabahn or stenosis within its transaortic portion. The patient remained well after 1-year follow-up. CONCLUSION: This transaortic modification may be a useful option for hybrid EVAR and application of a sutureless telescoping anastomosis technique.
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