Direct Abdominal Visceral Revascularization for Type B Aortic Dissection

Direct visceral organ debranching and bypass from the ascending aorta through the diaphragm is an advanced hybrid strategy used for patients with extensive type B aortic dissection that extends proximally to involve the left subclavian artery and distally across the visceral segment. In this approach, the ascending aorta provides a stable, high-quality inflow source for a multibranched graft that is tunneled retrosternally or via the pericardial cavity and passed through the diaphragm into the abdominal cavity. Sequential anastomoses are created to the celiac trunk, superior mesenteric artery, and renal arteries, effectively revascularizing the visceral organs independent of the diseased thoracoabdominal aorta. This restores perfusion, prevents malperfusion-related ischemia, and establishes a protected outflow for subsequent thoracic endovascular aortic repair (TEVAR). By fully bypassing the compromised segment and addressing proximal subclavian involvement - often with concurrent carotid-subclavian bypass - the technique provides durable organ protection while allowing safe exclusion of the dissected aortic segment in a staged or single-session hybrid repair.