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A hybrid clampless technique for aortic anastomoses
Open accessAbstract
BACKGROUND AND PURPOSE: In various circumstances of aortic repairs (heavy circumferential calcifications or shaggy aorta with extensive thrombus), open and endovascular techniques are at high risk. In addition to a likelihood of emboli, aortic clamping can be complicated by rupture and endovascular techniques may not be successful. We here describe a simple and reproducible hybrid technique that allows performing an aortic anastomosis without clamping in these situations. METHODS: After a limited exposure of the anterior aortic wall in a healthy segment, a prosthetic graft is sutured without any arteriotomy or clamping (adventitial suture), mimicking the final aspect of an end-to-side anastomosis. The graft and the anastomosis site are punctured using a long needle, allowing a guidewire to be positioned in the aorta under fluoroscopic guidance. Protected covered stenting of the anastomosis site opens the anastomosis without aortic clamping. After tunneling the graft to the target artery, the distal anastomosis is performed in a usual fashion. RESULTS: This technique was successfully used in 10 challenging consecutive cases with a sustained patency. CONCLUSIONS: This hybrid clampless technique for aortic anastomosis represents a useful alternative for challenging lesions unsuitable for a simple open or endovascular treatment.
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“Reports suggest that retrograde grafts perform as well as antegrade grafts.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [81]
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Research works printed but not linked: 15
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- Chiesa, 2014, Use of a novel hybrid vascular graft for sutureless revascularization of the renal arteries during open thoracoabdominal aortic aneurysm repair, J Vasc Surg, 60, 622, 10.1016/j.jvs.2014.03.256 · DOI
- Kato, 2015, Real chimney technique for total debranching of supra-aortic trunks, J Vasc Surg, 61, 542, 10.1016/j.jvs.2014.08.066 · DOI
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Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123
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Metadata
- Authors
- Renard, R., Coscas, R., Sylvestre, R., Javerliat, I., Goëau-Brissonnière, O., & Coggia, M.
- Affiliations
- Assistance Publique – Hôpitaux de Paris (FR)
- Inserm (FR)
- Corresponding author
- Coscas, Raphaël
- Venue
- Journal of Vascular Surgery Cases, Innovations and Techniques
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 7
- Issue
- 1
- Pages
- 137-141
- ISSN
- 2352-667X (ISSN-L)
- 2468-4287
- PMC
- PMC7921192
- OpenAlex
- W3083948368
- Cited by
- 4
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 1
- FWCI
- 0.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery Cases and Innovative Techniques (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Medtronic
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Surgery › Aortic aneurysm repair treatments
- Health Sciences › Medicine › Surgery › Infectious Aortic and Vascular Conditions
- Keywords
- hybrid technique, aortic anastomosis, aortic calcification, aortic thrombus, prosthetic graft, guidewire, aortic reconstruction, graft patency
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