title: Open aortic surgical repair for left hemi-arch stent-graft failure.
abstract: A surgical technique of endovascular graft explant through an open aortic approach for left hemi-arch stent-graft failure is described. Between January and April 2003, we surgically treated 3 patients previously submitted for stent grafts for isthmic aortic diseases. Two patients had atherosclerotic aneurysm and 1 had a false lumen reperfusion of subacute intramural hematoma. At 6 to 8 months computed tomographic scan follow-ups on all patients showed a rapid enlargement of aortic diameters due to type I endoleaks. The presence of an uncovered proximal stent in the parasubclavian aorta did not allow a simple aortic cross clamping; therefore we performed an open aortic procedure through a left posterolateral thoracotomy, using femoro-femoral bypass and mild hypothermic circulatory arrest. Selective antegrade cerebral perfusion was started within 3 to 5 minutes from aortotomy and graft removal. Left hemi-arch and descending thoracic aortic replacement was then performed with continuous cerebral perfusion. No surgical mortality was observed. Postoperative course was uneventful for neurologic, cardiac, respiratory, and renal complications. The 3-month follow-ups were event free. This approach, associated with rapid stent-graft explant and selective cerebral antegrade perfusion, appears to be a safe and effective surgical strategy for treating this new aortic pathology.
authors.affiliation: Department of Vascular Surgery, Istituto Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rampoldi
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: Paolo
authors.initials: P
authors.lastname: Righini
authors.forename: Valerio
authors.initials: V
authors.lastname: Tolva
authors.forename: Luigi
authors.initials: L
authors.lastname: Inglese
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001161:Arteriosclerosis / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015607:Stents; D013908:Thoracotomy / Q000379:methods*