title: Surgical repair of a distal arch aneurysm with a stent-graft.
abstract: This study evaluates the effectiveness and potential complications of stent-grafting for the treatment of distal arch aneurysms using profound hypothermia and circulatory arrest with retrograde cerebral perfusion. Between December 1998 and December 2001, 9 consecutive patients with a distal arch aneurysm (6 men and 3 women, mean age 71 years) underwent surgical repair using a stent-graft. Profound hypothermic circulatory arrest and retrograde cerebral perfusion were performed in all patients. Endovascular leakage was screened postoperatively using three-dimensional computerized tomography. The mean follow-up period was 27.4 months. Thirty day mortality was 0%. One patient died 3 months after stent-grafting due to proximal leakage into her aneurysm. The mean postoperative extubation period was 2.1 days. No patients suffered cerebral infarction or paraplegia. Although preliminary outcomes using this technique were good, endovascular leakage is a concern. We suggest that, if major proximal leakage is recognized postoperatively, re-intervention should be performed as soon as possible. Endovascular stent-grafting appears to be a good alternative treatment for distal arch aneurysms, although longer follow-up is necessary to more comprehensively evaluate this procedure.
authors.affiliation: Department of Cardiac Surgery, Asahi General Hospital, I-1236 Asahi, Chiba 289-2511, Japan. higux@blue.ocn.ne.jp
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Higuchi
authors.forename: Kenzi
authors.initials: K
authors.lastname: Koseni
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Hisaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kotsuka
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome