title: Alternative surgical approach to treat aortic arch aneurysm after ascending aortic replacement with hybrid prosthesis.
abstract: We present a surgical technique to treat the distal aortic arch in patients who previously underwent ascending aortic replacement using the frozen elephant trunk. After debranching of the epiaortic vessels using a custom-made four-branch graft and systemic cooling, the extracorporeal circulation is interrupted, maintaining antegrade cerebral perfusion through the four-branch prosthesis. Then the "old" Dacron prosthesis, previously implanted for the ascending aortic replacement, is partially incised at its distal end, leaving a margin of prosthesis anastomosed to the native distal aorta, and the E-vita stent-graft is deployed under direct vision. Then the two margins of the "old" Dacron and the new Dacron E-vita prosthesis (Jotec Inc., Hechingen, Germany) are sutured together with one suture line to guarantee sealing and reconstruction of the aorta. This technique presents several advantages: the discrepancy between the graft size and the native aortic diameter is avoided, performing the anastomosis between two prosthetic materials with similar diameters is easier; there is no risk of tears in the diseased native aortic wall and related bleeding; and finally, it is easier to perform the anastomosis at the level of the ascending aorta rather than at the distal arch, especially when the disease of the aorta is extended to the descending segment.
authors: Department of Cardiac Surgery Unit, University Tor Vergata, Policlinico Tor Vergata, Rome, Italy.
authors: Jacob
authors: J
authors: Zeitani
authors: Paolo
authors: P
authors: Nardi
authors: Kyriakos
authors: K
authors: Bellos
authors: Silvia
authors: S
authors: De Propris
authors: Luigi
authors: L
authors: Chiariello
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D020878:Device Removal; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D012086:Reoperation; D015607:Stents; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates