Preoperative planning for the selection of the reimplantation method of reno-visceral branches during thoracoabdominal aortic reconstructions

Introduction. Thoracoabdominal aortic (TAA) replacement is a complex surgical procedure that requires reconstruction and reimplantation of the renovisceral branches (RVB). The choice of the optimal method for RVB reimplantation plays an important role in achieving long-term success of the operation.

Objective. To analyze and evaluate preoperative parameters of CTA aortography and anatomical and morphological characteristics of RVB and determine their influence on the choice of RVB reimplantation technique during TAA reconstruction.

Materials and methods. At the B.V. Petrovsky Russian Scientific Center of Surgery, a retrospective analysis of data from 120 patients was carried out as part of the study from 01.2018 to 09.2023, who underwent TAA prosthetics with implantation of all RVB. Preoperative data and parameters of the aorta and RVB according to MSCT aortography were evaluated. Patients were divided into three groups; group I — «Crawford» (n=43, 35,8 %), gr. II — «Coselli» (n=32, 26,7 %), III gr. — «buttons» (n=45, 37,5 %).

Results. 1) «Crawford» should be chosen in elderly patients with close location of the RVB ostia in relation to each other, in the absence of connective tissue disease (CTD) and degenerative lesions of the RVB. 2) «Coselli» is appropriate for patients with a large diameter of the aneurysm at the level of the RVB (p<0,001). The technique has an advantage in patients with "shaggy aorta" and morphologically altered RVB (stenosis, occlusion, dissection) – p=0,001 and p<0,050, respectively. 3) The «button» method is advisable to use with a remote reno-visceral location (p=0,001), in patients with CTD (p=0,012) and with variant RVB anatomy (p<0,050).

Conclusion. Preoperative planning based on anthropometric data and MSCT allows developing a strategy for RVB reimplantation, taking into account aortic pathology and minimizing the risk of complications.

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