First in Human Implantation of the Thoracoflo Graft: A New Hybrid Device for Thoraco-Abdominal Aortic Repair

Eike Sebastian Debus; Karolina Malik; Tilo Kölbel; Susanne Honig; Jens Brickwedel; Christoph Behem; Sabine Helena Wipper

doi:10.1016/j.ejvsvf.2023.02.002

First in Human Implantation of the Thoracoflo Graft: A New Hybrid Device for Thoraco-Abdominal Aortic Repair

EJVES Vasc Forum. 2023 Mar 7:58:28-31. doi: 10.1016/j.ejvsvf.2023.02.002. eCollection 2023.

Authors

Eike Sebastian Debus¹, Karolina Malik¹, Tilo Kölbel¹, Susanne Honig¹, Jens Brickwedel², Christoph Behem³, Sabine Helena Wipper⁴

Affiliations

¹ Department for Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, German Aortic Centre Hamburg, University Heart & Vascular Centre, University Hospital Eppendorf, Hamburg, Germany.
² Department for Heart & and Vascular Surgery, University Heart & Vascular Centre, University Hospital Eppendorf, Hamburg, Germany.
³ Department for Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany.
⁴ Medical University Innsbruck, Department for Vascular Surgery, Innsbruck, Austria.

Abstract

Introduction: Despite a high rate of success when performed in specialised centres, current techniques for thoraco-abdominal aortic repair are associated with serious complications. The problem of spinal cord ischaemia remains unsolved.

Surgical technique: The new hybrid graft for thoraco-abdominal aortic repair was developed based on the frozen elephant trunk principle. The device consists of a proximal stent graft for transabdominal retrograde delivery to the descending thoracic aorta, combined with a distal six branched abdominal device for open aortic repair. An additional seventh branch is provided for possible lumbar artery re-implantation. Because the stent graft is implanted via a transabdominal approach, it avoids the need for thoracotomy and extracorporeal circulation. A 56 year old patient with Loeys-Dietz syndrome was placed in a supine position. The aorto-iliac axis was exposed via a midline transperitoneal approach. Following an end to side anastomosis of the iliac branch to the left common iliac artery, the stent graft portion was inserted into the thoracic aorta via the coeliac trunk ostium. After stent implantation and graft de-airing by needle puncture, retrograde blood flow to the abdominal aortic segment, and the lumbar and visceral arteries was established via the end to side iliac anastomosis creating an extra-anatomic bypass. Subsequently, the visceral and renal arteries were anastomosed to the branches. Finally, the aorta was opened and surgical graft attached via the collar. The reconstruction ended with end to end anastomoses of both common iliac arteries to the graft branches.

Discussion: The first and successful implantation of the new Thoracoflo hybrid device via a novel surgical technique is reported, eliminating the need for thoracotomy and extracorporeal circulation for thoraco-abdominal aortic repair.

Keywords: Hybrid device; Thoracoabdominal repair; Thoracoflo.