title: Hybrid technique for total arch repair: aortic neck reshaping for endovascular-graft fixation.
abstract: OBJECTIVE
  Endovascular repairs of the aortic arch aneurysms require correct placement and an appropriate landing zone for fixation, which are not present in the majority of cases.
  
  
  METHODS
  We report a less invasive approach in 4 patients presenting an aortic arch aneurysm. We performed a hybrid procedure that is a combination of different techniques: a mid-sternotomy is performed, followed by transposition of the supra-aortic vessels, and neck reshaping with a proximal banding of the aortic arch. In particular, we banded the aorta to facilitate and optimize the endovascular fixation of the graft, reducing postoperative type-1 endoleaks.
  
  
  RESULTS
  The four procedures were uneventful with 1-day intensive care unit recovery. The postoperative and the 1-year follow-up CT scan did not reveal any endoleaks.
  
  
  CONCLUSIONS
  Hybrid technique, combined with banding of proximal aortic arch and endovascular grafting are an alternative technique to the conventional open aortic repair. A polyester cloth banding of the ascending and proximal aortic arch allow the neck reshaping of the aorta optimizing the fixation of the endovascular stent graft.
authors.affiliation: Department of Cardiovascular Surgery, Azienda Ospedaliera Polo Universitario Luigi Sacco, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Antona
authors.forename: Paolo
authors.initials: P
authors.lastname: Vanelli
authors.forename: Marina
authors.initials: M
authors.lastname: Petullà
authors.forename: Guido
authors.initials: G
authors.lastname: Gelpi
authors.forename: Paolo
authors.initials: P
authors.lastname: Danna
authors.forename: Massimo
authors.initials: M
authors.lastname: Lemma
authors.forename: Luigi
authors.initials: L
authors.lastname: Inglese
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011184:Postoperative Period; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*