Adventitial inversion with graft telescopic insertion for distal anastomosis in acute type a aortic dissection.

PURPOSE One current method of anastomosis in aortic dissection type A is the adventitial inversion technique. To improve hemostasis at the anastomotic site, we have developed a novel technique for distal anastomosis involving adventitial inversion employing graft telescopic insertion. METHODS The adventitia was inverted into the aortic lumen and the anastomosis with a Dacron tube-graft was made in a telescopic method, covering the inverted adventitia. RESULTS Five patients have undergone emergency ascending aortic replacement for aortic dissection by one surgeon using this technique. There have been no reoperations for bleeding or false aneurysm. CONCLUSION Complete coverage of the inverted adventitia eliminated the potential risk of thrombus formation. Graft telescopic insertion lead to complete hemostasis.