Midterm Performance of the Autologous Adventitial Overlay Method in Aortic Surgery

We developed an adventitial overlay method for reinforcing aortic anastomoses. This study evaluated the midterm morphological and clinical outcomes of this method.We harvested and prepared adventitia from a resected aneurysm or dissected aortic wall and performed aortic repair using the adventitial overlay method. At the midterm follow-up, we examined the differences among overlay, inversion, and felt-sandwich (FS) methods by evaluating the morphology of the anastomosis using computed tomography (CT) scans. Moreover, we performed macroscopic evaluation of one patient who required a second operation.Between May 2009 and April 2020, 160 consecutive patients (104 males, 56 females; mean age, 68.6 ± 11; range, 39-88 years) underwent thoracic aortic surgery. The overlay technique was successfully performed in 84 cases. The anastomosis sites of the overlay method maintained their morphology without any clinical complications. The inner diameter ratio of anastomosis/graft was measured using CT, which revealed that the overlay method was not significantly different from inversion and was significantly larger than the FS method. There was no anastomotic stenosis in the proximal or distal overlay anastomosis. Only one patient required a second operation for an enlarged aneurysm of the distal false lumen. We observed that the proximal overlaid adventitia was smoothly attached to the native lumen and was macroscopically indistinguishable from the original intima.This study showed the midterm stability of the overlay technique. The midterm outcome was clinically acceptable. No anastomotic stenosis or pseudoaneurysm formation in either the true aortic aneurysm or dissection cases was observed.