ORIGINAL ARTICLE New Technique to Facilitate Renal Revascularization with Use of Telescoping Self-Expanding Stent Grafts: VORTEC Mario Lachat*, Dieter Mayer*, Frank J. Criado { , Thomas Pfammatter{, Zoran Rancic*, Michele Genoni*, and Frank J. Veith*1 This article describes a new, less invasive prosthetic graft anastomotic technique that uses self-expanding stent grafts that are ‘‘telescoped’’ into aortic branches. This method, the VORTEC (Viabahn Open Revascularization TEChnique), obviates the need for potentially difficult complete vessel exposure and graft anastomoses, thereby reducing the duration of flow interruption and simplifying the performance of complex aortic reconstructions and so-called debranching procedures requiring reconstruction of major branches such as renal arteries. Minimal exposure of one surface of the renal artery allowed introduction and deployment of a self-expanding Viabahn (W.L. Gore & Associates, Flagstaff, AZ) device using the Seldinger technique. The Viabahn devices used were 5 to 8 mm in diameter and 5 to 15 cm in length depending on individual anatomy (assessed by preoperative computed tomographic angiography). Overall, 82 renal arteries have been revascularized in 58 patients using the VORTEC. The technical success rate was 100%, with all of the stent grafts implanted as intended with maintenance of flow. The patency rates were 97% after 30 days and 96% after a mean follow-up of 18 months (range 1–38 months). The VORTEC allows performance of safe and expeditious revascularization of renal arteries. This new technique may represent significant improvement over the standard approach of surgical exposure and sutured anastomosis. Key words: nonsuture anastomosis, Hybride procedure, pararenal or thoracoabdominal aneurysm, renal artery revascularization, stent graft anastomosis, visceral debranching S tandard anastomotic technique requires extensive exposure, circumferential dissection, and occlusion of vessels. Performance of the anastomosis can be difficult and time-consuming, leading to prolonged flow interrup- tion and organ ischemia. This standard anastomotic technique was originally described by Alexis Carrel in 1902. 1 Although a number of improvements and mod- ifications followed, 2 none were truly advantageous. The need for a better solution that minimizes dissection, exposure, and vessel occlusion is obvious. We describe herein a new technique (Viabahn Open Revascularization TEChnique [VORTEC]) that requires only minimal vessel exposure, obviates the need for vessel cross-clamping or anastomotic suturing, and reduces significantly the dura- tion of blood flow interruption. Material and Methods From January 2004 to December 2007, the VORTEC was used in 58 patients with abdominal or thoracoabdominal aortic aneurysms requiring intra-abdominal debranching and extra-anatomic revascularization of one or both renal arteries before simultaneous or stepped exclusion of the aneurysm. Computed tomographic angiography (CTA) was obtained in all cases to delineate renal artery anatomy, to measure vessel lengths and diameters, and to identify possible severe renal artery stenosis that might require adjunctive endarterectomy (Figure 1). A 5 or 6 mm in diameter Viabahn graft (5, 10, or 15 cm in length; Gore & Associates, Flagstaff, AZ) was used in all cases, representing approximately 10% oversizing. Overall, 82 renal arteries were revascularized using the VORTEC. To perform VORTEC, the origin of the renal artery was identified and only 1 cm of the anterior wall was exposed. After puncturing the arterial wall, the Viabahn device was *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; { Department of Vascular Surgery, Union Memorial Hospital-MedStar Health, Baltimore, MD; { Department of Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; and 1 The Cleveland Clinic and New York University Medical Center, New York, NY. Correspondence to: Mario Lachat, MD, Clinic for Cardiovascular Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; tel: +41 44 255 36 90; fax: +41 44 255 87 88; e-mail: mario.lachat@usz.ch. Vascular, Vol. 16, No. 2, pp. 69–72, 2007. Printed in USA The International Society for Vascular Surgery # BC Decker Inc. All rights reserved. ISSN: 1708-5381. DOI: 10.2310/6670.2008.00026 69