Modified intercostal artery reconstruction technique for thoracoabdominal aortic aneurysm repair

Objective

Spinal cord ischemia is a serious complication of thoracoabdominal aortic aneurysm repair. This study evaluates a modified intercostal artery reconstruction technique for preserving spinal cord perfusion, with a focus on graft patency and early outcomes.

Methods

Between 2023 and 2024, 24 patients (mean age, 46 ± 11 years) underwent thoracoabdominal aortic aneurysm repair (4 Crawford type I, 9 type II, 11 type III) using a modified intercostal artery reconstruction technique. Intercostal artery segments from both sides between the eighth thoracic and first lumbar vertebrae were sutured together to form an aortic roll and then anastomosed side-to-side with the Dacron vascular graft. Computed tomography angiography was performed before discharge and during follow-up to assess patency and complications.

Results

No cases of spinal cord ischemia, neurological deficits, or deaths occurred. Before discharge, imaging confirmed graft patency in 22 patients, 2 patients had complete aortic roll occlusion, and 1 patient showed occlusion of a single intercostal artery branch. None required further intervention or developed complications. The aortic roll diameter remained unchanged (1.18 ± 0.29 cm before discharge vs 1.18 ± 0.35 cm at follow-up, P = .94). The side-to-side anastomosis diameter showed no significant change over 1 year (0.62 ± 0.14 cm vs 0.67 ± 0.16 cm, P = .10). One-year follow-up in 6 patients revealed no new occlusions, aneurysm formation, or late complications, indicating stable reconstruction.

Conclusions

This technique demonstrated excellent graft patency and favorable early outcomes, offering a promising strategy to improve surgical outcomes in thoracoabdominal aortic aneurysm repair.