Transposition of the supraaortic branches for extended endovascular arch repair.
BACKGROUND
Supraaortic branches limit extended application of endovascular aortic repair. For this purpose, we applied extensive reconstructions.


METHODS
Between October 2002 and March 2005, 11 patients (mean age 72.3 years) presented with acute or chronic aortic diseases originating from the aortic arch (arch aneurysms n=8, type B dissections n=3). Treatment was by autologous sequential transposition of the left carotid artery into the brachiocephalic trunk and of the left subclavian artery into the already transposed left common carotid artery in nine patients and by additional reconstruction of the brachiocephalic trunk in two patients. Endovascular stent-graft placement was successfully performed thereafter.


RESULTS
Procedure-related mortality was 0%. At completion angiography, all reconstructions were fully patent. One patient had a small type Ia endoleak that resolved spontaneously within one week. Mean follow-up was 18 months (1-29 months). One patient underwent redo stent-graft placement after 25 months due to a type III endoleak. The remaining patients had normal follow-up CT scans with regular perfusion of the supraaortic branches without any signs of endoleaks.


CONCLUSIONS
Extended application of this technique will enable safe and effective treatment of a highly selected group of patients by avoiding conventional repair.
Czerny
Martin
M
Department of Cardiothoracic Surgery, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria. bypass@eunet.at
Gottardi
Roman
R
Zimpfer
Daniel
D
Schoder
Maria
M
Grabenwoger
Martin
M
Lammer
Johannes
J
Wolner
Ernst
E
Grimm
Michael
M
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000601:surgery; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency