Endovascular aortic arch repair after aortic arch de-branching.
OBJECTIVE
Conventional surgical therapy of aortic arch aneurysms consists of aortic arch replacement requiring cardiopulmonary bypass and deep hypothermic circulatory arrest. This method is associated with significant morbidity and mortality, mainly due to neurologic complications and the sequelae of deep hypothermic circulatory arrest. Thus, it makes sense to work on developing less invasive surgical techniques.


METHODS
Surgical aortic arch de-branching is required before the supra-aortic vessels can be safely covered by an endovascular stent graft. We describe how the supra-aortic vessels can best be revascularized, followed by complete coverage of the aortic arch with endovascular stent grafts.


RESULTS
We hereby present our case selection criteria, preoperative work-up, and surgical approach for aortic arch de-branching with supra-aortic revascularization, followed by complete coverage of the aortic arch by endovascular stent grafting. This technique's safeguards and pitfalls are described for a cohort of 26 patients.


CONCLUSIONS
Endovascular aortic arch repair after aortic arch de-branching has the potential to lower the morbidity and mortality rates in patients with aortic arch diseases.
Weigang
Ernst
E
Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany. weigang@uni-mainz.de
Parker
Jack
J
Czerny
Martin
M
Peivandi
Ali A
AA
Dorweiler
Bernhard
B
Beyersdorf
Friedhelm
F
Siegenthaler
Michael P
MP
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017130:Angioplasty / Q000379:methods; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011300:Preoperative Care; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*