Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching.
We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta.
Zierer
Andreas
A
Division of Cardiothoracic Surgery, Center for Diseases of the Thoracic Aorta, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Sanchez
Luis A
LA
Moon
Marc R
MR
D000714:Anastomosis, Surgical; D000792:Angiography; D017130:Angioplasty / Q000379:methods*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012494:Sampling Studies; D015607:Stents; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods