Kidney Autotransplantation and “Debranch-First” Technique for Thoracoabdominal Stent-Graft Infection

Objective: To present the surgical management of a 22-year-old patient with midaortic syndrome, symptomatic for claudication and renovascular hypertension, with infected aortic and renal stent grafts. Key Steps: Procedures were performed as follows: 1) right renal autotransplantation through a transperitoneal approach and midline abdominal incision; 2) thoracotomy with left visceral rotation and visceral vessel exposure; 3) left-heart bypass and “debranch-first” technique, with warm blood perfusion for the splanchnic vessels and cold Custodiol solution for renal perfusion; 4) aortic replacement with a tubular xenopericardium graft; and 5) separate reattachment of visceral vessel to the main tubular graft. Potential Pitfalls: Recurrent infections of the xenopericardium graft, kidney parenchyma loss, and major complications such as spinal cord ischemia, represent potential pitfalls to this procedure. Take-Home Message: Kidney autotransplantation allows right renal–infected stent graft removal before in situ thoracoabdominal reconstruction through left thoracoabdominal access, preserving renal function against renovascular hypertension.