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<p>Thoracoabdominal aortic aneurysms (TAAAs) represent a technically demanding and high-risk subset of aortic pathology, carrying significant perioperative morbidity and mortality under conventional open repair. Endovascular strategies, while less invasive, face anatomical and hemodynamic constraints that limit their broad applicability in complex TAAA configurations. The Thoracoflo hybrid graft is a novel investigational device conceived to integrate the revascularization completeness of open surgery with the reduced physiological burden of endovascular approaches, enabling single-stage TAAA repair without thoracotomy or extracorporeal circulation. The device consists of a proximal self-expanding nitinol stent graft designed for retrograde deployment into the descending thoracic aorta and a distal gelatin-sealed multibranched polyester graft for visceral, renal, lumbar, and iliac vessel reimplantation. A key operational principle is the Selective Perfusion During Endovascular Repair (SPIDER) technique, which maintains continuous pulsatile retrograde blood flow through a dedicated ilio-femoral anastomosis branch during sequential visceral vessel reconstruction, with the aim of reducing spinal cord and organ ischemic burden. Preclinical studies in porcine models have demonstrated technical feasibility, shortened ischemic times relative to conventional open constructs, and preservation of spinal cord perfusion through lumbar artery reimplantation. Early human experience remains confined to a small number of published case reports involving anatomically complex patients, in whom the device was deployed without major neurological deficit; however, no comparative, long-term, or population-level outcome data are available. This manuscript is a narrative technical review that synthesizes available preclinical findings, early clinical observations, and design rationale for the Thoracoflo graft. All conclusions should be interpreted as preliminary and hypothesis-generating. Robust evidence from prospective, multicenter, adequately powered clinical studies is required before definitive claims regarding the clinical efficacy, safety, or comparative advantage of this device can be made.</p>

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Hybrid Innovation in Aortic Surgery: The Thoracoflo Hybrid Graft — A Narrative Technical Review of a Novel Device for Thoracoabdominal Aortic Repair

  • 期刊论文

  • 发表日期：

    2026年5月21日

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  • Victor Olamiposi Olaiya,
  • Fidelis Ogenetega Ejeheri,
  • Akosua Bemah Adjei,
  • Eze Maryann Chioma,
  • Johnson Matola,
  • Agyekum Kuukua Vincentia,
  • Adediran Adelekan,
  • Tolulope Seyi Osinuga,
  • Adeoti Boluwatife Covenant

摘要

Thoracoabdominal aortic aneurysms (TAAAs) represent a technically demanding and high-risk subset of aortic pathology, carrying significant perioperative morbidity and mortality under conventional open repair. Endovascular strategies, while less invasive, face anatomical and hemodynamic constraints that limit their broad applicability in complex TAAA configurations. The Thoracoflo hybrid graft is a novel investigational device conceived to integrate the revascularization completeness of open surgery with the reduced physiological burden of endovascular approaches, enabling single-stage TAAA repair without thoracotomy or extracorporeal circulation. The device consists of a proximal self-expanding nitinol stent graft designed for retrograde deployment into the descending thoracic aorta and a distal gelatin-sealed multibranched polyester graft for visceral, renal, lumbar, and iliac vessel reimplantation. A key operational principle is the Selective Perfusion During Endovascular Repair (SPIDER) technique, which maintains continuous pulsatile retrograde blood flow through a dedicated ilio-femoral anastomosis branch during sequential visceral vessel reconstruction, with the aim of reducing spinal cord and organ ischemic burden. Preclinical studies in porcine models have demonstrated technical feasibility, shortened ischemic times relative to conventional open constructs, and preservation of spinal cord perfusion through lumbar artery reimplantation. Early human experience remains confined to a small number of published case reports involving anatomically complex patients, in whom the device was deployed without major neurological deficit; however, no comparative, long-term, or population-level outcome data are available. This manuscript is a narrative technical review that synthesizes available preclinical findings, early clinical observations, and design rationale for the Thoracoflo graft. All conclusions should be interpreted as preliminary and hypothesis-generating. Robust evidence from prospective, multicenter, adequately powered clinical studies is required before definitive claims regarding the clinical efficacy, safety, or comparative advantage of this device can be made.