title: Onion skin technique for open surgical replacement of aortic arch following primary endoprothesic thoracic aorta treatment.
abstract: Endovascular aortic replacement (EVAR) techniques have become the first choice option for many aortic diseases in patients in whom standard open surgery was contraindicated or with high surgical risk. A secondary open surgical treatment, following a primary EVAR procedure, could, however, be challenging depending on the type, the extension and the position of primary endoprosthesis. Here, we describe an original and easy technique capable of simplifying a secondary aortic arch replacement following EVAR treatment of the descending thoracic aorta. The basic concept of such techniques is similar to that of the conventional 'elephant trunk' technique and is based on an inverted straight tube graft inserted into the endoprosthesis and anastomized using a multi-layer double suture with external strip felt of Dacron.
authors.affiliation: Division of Cardiothoracic Surgery, Research Hospital Foundation San Matteo, Pavia, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Totaro
authors.forename: Eliana
authors.initials: E
authors.lastname: Raviola
authors.forename: Roberto
authors.initials: R
authors.lastname: Veronesi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzola
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006801:Humans; D012086:Reoperation
keywords: Aortic arch; Endoprosthesis; Redo surgery