Illustration of the reversed elephant trunk technique using a traditional “island” approach to total aortic arch replacement. A. Stage 1: The distal aorta.

Slides:

Advertisements

Similar presentations

The relationship between systolic blood pressure and mortality in trauma patients with hemorrhage. These data suggest that a systolic blood pressure of.

Advertisements

The authors’ sequential closure technique for the open abdomen. A

Tipos de miomas uterinos.

Common splints used for hand injuries/surgeries. A. Ulnar gutter splint. The ring and small fingers are included. The surgeon pushes on the dorsum of the.

Commons splints used for hand injuries/surgeries. A

A and B. Ghrelin secretion after bariatric surgery

Intraperitoneal view of polytetrafluoroethylene mesh used for laparoscopic ventral incisional hernia repair. The mesh is in place on the posterior aspect.

Intraperitoneal view of expanded polytetrafluoroethylene mesh used for laparoscopic ventral incisional hernia repair. The mesh is in place on the posterior.

Algorithm for treatment of colorectal hemorrhage

The four major categories of fistula in ano (left side of drawings) and the usual operative procedure to correct the fistula (right side of drawings).

Labeled urea breath test to detect Helicobacter infection

A. Layers of the abdominal wall in an anterior open approach to hernia repair. B. Identification of indirect and direct hernia sacs once the spermatic.

A. Radiogram of a type I (sliding) hiatal hernia. B

Intra-abdominal venous flow pathways leading to engorged veins (varices) from portal hypertension. 1, Coronary vein; 2, superior hemorrhoidal veins; 3,

Felon. A. Lateral view of the digit showing fluctuance between the skin of the pad and the underlying distal phalanx bone. B. The authors prefer to drain.

A. Open grade 3 comminuted tibia-fibula fracture (motorcycle injury). B. External fixator temporarily stabilizes grade 3 open tibia fracture. Source: Orthopedic.

Treatment pathways for stage IIIA and stage IIIB breast cancer.

Pain location in chronic pancreatitis

(Reproduced with permission from Jemal A, et al: Cancer statistics, CA Cancer J Clin 58:71, 2008.) Source: Chapter 17. The Breast, Schwartz's Principles.

Illustration of a hybrid arch repair. A

Mammography and xeromammography. A

Fat digestion. Long-chain triglycerides, which constitute the majority of dietary fats, must undergo lipolysis into constituent log-chain fatty acids and.

Modified radical mastectomy (Patey): axillary lymph node dissection

A. Anteroposterior cervical spine x-ray showing the position of an anterior cervical plate used for stabilization after C6–C7 discectomy. Patient presented.

Removal of varicose veins via stab avulsions.

A. A neuropathic ulcer is characterized by a punched-out appearance with loss of sensation in the surrounding skin. The foot may be warm to touch, and.

MR imaging of a torn ACL. (A-C) Proton density sagittal cuts; showing anteroposterior tibial insertion site length measurement “x”, intra-articular ligament.

Transgastric passage of circular EEA stapler to create gastrojejuostomy for laparoscopic Roux-en-Y gastric bypass. (Reproduced with permission from Schneider.

Metal fitting aid to assist in placement of elastic compression stockings. Source: Chapter 24. Venous and Lymphatic Disease, Schwartz's Principles of Surgery,

Anatomy of the left portal vein (LPV)

Reproduced, with permission, from Bahnson HT, Nelson AR

[Reproduced with permission from Healey JE, Hodge J (eds): Surgical Anatomy, 2nd ed. Toronto: BC Decker, 1990, p 153.] Source: Chapter 35. Abdominal Wall,

Calcium balance and fluxes in a normal human

Denver Health Medical Center’s Massive Transfusion Protocol

Thoracoabdominal Aortic Aneurysm Repair: Open Technique

Ultrasonography images of malignant breast lesions. A

The distal transition line (left side of the picture) in the internal carotid artery where the plaque had been removed must be examined carefully and should.

Computed tomography (CT)–positron emission tomography (PET) scans before and after resection of liver metastasis from colorectal cancer in a 54-year-old.

Pie chart comparison of pain control at 3 weeks after lobectomy by standard thoracotomy or video-assisted thoracic surgery (VATS). The pie charts show.

Negative pressure wound therapy in a patient after amputation for wet gangrene (A), and in a patient with enterocutaneous fistula (B). It is possible to.

Breast cyst. A. Simple cyst

Algorithm for the management of hepatocellular carcinoma (HCC)

Algorithm for the management of hepatocellular carcinoma (HCC)

Pancreatic neuroendocrine tumor (PNET) demonstrating enhancement during arterial phase of CT scan. Pancreatic head PNET seen in (left) sagital, (middle)

(Fig A reproduced with permission from Cummings DE, et al: Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl.

A. Sites of the most severe pain during an episode of biliary pain in 107 patients with gallstones (% values add up to >100% because of multiple responses).

Robotic instruments and hand controls

A and B. Ghrelin secretion after bariatric surgery

Extensive DCIS seen on mammography. A

Open Repair of Distal Aortic Arch and Proximal Descending Thoracic Aortic Aneurysm Using a Stepwise Distal Anastomosis Hitoshi Ogino, MD Operative Techniques.

Drawings illustrating an extent II repair of a thoracoabdominal aortic aneurysm (A) that extends from the left subclavian artery to the aortoiliac bifurcation.

Ductal carcinoma in situ (DCIS). A

Open Repair of Distal Aortic Arch and Proximal Descending Thoracic Aortic Aneurysm Using a Stepwise Distal Anastomosis Hitoshi Ogino, MD Operative Techniques.

Thoracoabdominal Aortic Aneurysm Repair: Open Technique

Does Cross-Clamping the Arch Increase the Risk of Descending Thoracic and Thoracoabdominal Aneurysm Repair? Leonard N. Girardi, MD, Karl H. Krieger,

George Matalanis, MBMS, FRACS, Rhiannon S. Koirala, MBBS, William Y

Joseph S. Coselli, MD, Peter Oberwalder, MD

The Reversed Elephant Trunk Technique Used for Treatment of Complex Aneurysms of the Entire Thoracic Aorta Joseph S. Coselli, MD, Scott A. LeMaire, MD,

Lars G. Svensson, MD, PhD, Gregory D

Joseph S Coselli, Luiz F.Poli de Figueiredo, Scott A LeMaire

Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm With a Right-Sided Aortic Arch and Aberrant Left Subclavian Artery Joseph J.

Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients Koichi Toda, MD, Kazuhiro Taniguchi, MD, Takafumi Masai, MD, Toshiki.

Pan-aortic hybrid treatment of mega-aorta syndrome

Three-graft technique for ascending aorta and total aortic arch replacement Gen-ya Yaginuma, MD, Yoshiyuki Iijima, MD, Kazuo Abe, MD, Yoshiyuki Okada,

G. Chad Hughes, MD, Mani A. Daneshmand, MD, Keki R

Arch-first technique for aortic arch aneurysm repair through median sternotomy Motonobu Nishimura, MD, Shigeaki Ohtake, MD, Yoshiki Sawa, MD, Toshiki.

Shih-Rong Hsieh, MD, Chien-Chang Chen, MD, Hao-Ji Wei, MD

Integrated Total Arch Replacement Using Selective Cerebral Perfusion: A 6-Year Experience Hiroaki Sasaki, MD, Hitoshi Ogino, MD, Hitoshi Matsuda, MD,

A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach Juan Carlos Jimenez, MD, Wesley.

David Spielvogel, MD, James C

Presentation transcript:

Illustration of the reversed elephant trunk technique using a traditional “island” approach to total aortic arch replacement. A. Stage 1: The distal aorta is repaired through a left thoracoabdominal approach. The aneurysm is opened after the aorta is clamped between the left common carotid artery and the left subclavian artery, which is also clamped. Before the proximal anastomosis is performed, the end of the graft is partly invaginated to leave a “trunk” for the subsequent repair. Proximal intercostal arteries are oversewn. B. After the proximal suture line is completed, the clamps are repositioned to restore blood flow to the left subclavian artery. The repair is completed by reattaching patent intercostal arteries to an opening in the side of the graft and creating a beveled distal anastomosis at the level of the visceral branches. C. Stage 2: The proximal aorta is repaired through a median sternotomy. The aortic arch is opened under hypothermic circulatory arrest. The “trunk” is pulled out and used to replace the aortic arch and ascending aorta. This eliminates the need for a new distal anastomosis and simplifies the procedure. Circulatory arrest and operative time, along with their attendant risks, are reduced. D. The completed two-stage repair of the entire thoracic aorta. (Reproduced with permission from Coselli JS, LeMaire SA, Carter SA, et al: The reversed elephant trunk technique used for treatment of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg 2005; 80:2166, Figs. 2, 3, 7,8. Copyright The Society of Thoracic Surgeons.) Source: Thoracic Aneurysms and Aortic Dissection, Schwartz's Principles of Surgery, 10e Citation: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. Schwartz's Principles of Surgery, 10e; 2014 Available at: http://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/980/bru_ch22_f013.png&sec=100397277&BookID=980&ChapterSecID=59610864&imagename= Accessed: October 27, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved