Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm

We explore a modified octopus technique for endovascular repair of thoracic abdominal aortic aneurysm, involving visceral artery reconstruction. We are testing if this technique effectively reduced endo leaks and stent compression, and whether it offered a simple, safer alternative for complex TAAA case, and suitable for open surgery.

We use the one in the Western technologies, such as French and branch stent grafts, physician modified endograft, and the parallel grafting techniques, including the octopus method to reconstruct vessel branches.

Our modified octopus technique minimize gut related endo leaks, redux steel stand compression, and enables visual artery construction for a single operating access.

[Narrator] To begin, perform the surgical planning and obtain all the required measurements. Extend the 30 to 200 millimeter thoracic aortic stent graft to establish the proximal anchoring zone. Take four stent graft segments of different lengths and suture branches to each segment accordingly. Suture the branch for the celiac trunk at the bifurcation point of the abdominal aortic stent graft. Now pair and securely suture the three branches designated for the superior mesenteric artery and the bilateral renal arteries. To create a common seam, suture the junctions between the three stent grafts, and perform an end-to-end anastomosis at the short branch of the abdominal aortic stent graft. Use a modified stent graft, referred to as the octopus configuration, derived from an abdominal aortic stent for internal bridging and adjust the release height of the branches to enable seamless bridging of the covered stent grafts. Now puncture the right common femoral artery, and insert a nine French arterial sheath. Advance a centimeter sizing catheter to the aortic arch and visualize the descending aorta and thoracoabdominal aortic aneurysm. Bridge the proximal end first with a thoracic aortic stent graft main body, then place the modified octopus branch stent. Advance a guide wire and catheter to the main stent body, and then replace the sheath with an eight French, 90 centimeter long sheath. Then deploy eight to 100 millimeter and seven to 100 millimeter stent grafts to reconstruct the celiac trunk and the superior mesenteric artery, respectively. Place a six to 100 millimeter stent graft for the right renal artery, and place the six to 100 millimeter graft in the right renal artery. To address the acute angle of the left renal artery, deploy a six to 100 millimeter covered stent graft. Release a long leg side abdominal aortic covered stent graft extension with trumpet legs measuring 16 to 24 to 124 millimeters, anchoring it in the distal abdominal aorta. Then deploy the left renal artery stent graft and reinforce with a six to 60 millimeter bare metal stent. Once the angiographic results are confirmed as satisfactory, remove the catheter, guide wire and sheath. Tighten the pre placed sutures at the right femoral artery puncture site. Finally, apply direct compression to the puncture site of the left brachial artery to achieve hemostasis, and place a compressive dressing over the site. The modified octopus technique closely aligns with the design concept of branched stents. Postoperative aortic computed tomography and geography demonstrated successful exclusion of the thoracoabdominal aortic aneurysm with unobstructed blood flow within the stent and to the branch arteries.