Hybrid thoracic endovascular aortic repair: Pushing the envelope

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Hybrid thoracic endovascular aortic repair: Pushing the envelope Houssam K. Younes, MD, Mark G. Davies, MD, PhD, MBA, Jean Bismuth, MD, Joseph J. Naoum, MD, Eric K. Peden, MD, Michael J. Reardon, MD, Alan B. Lumsden, MD Journal of Vascular Surgery Volume 51, Issue 1, Pages 259-266 (January 2010) DOI: 10.1016/j.jvs.2009.09.043 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Schematic demonstrations showing A: Arch vessels debranching using 14-mm inflow conduit from ascending aorta followed by 10-mm bypass graft to the innominate, left common carotid and left subclavian arteries; B: Arch vessels debranching using 10-mm dacron graft with retrograde inflow through 10-mm graft. Endograft was delivered using 14-mm conduit. Copyright to the Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center. Journal of Vascular Surgery 2010 51, 259-266DOI: (10.1016/j.jvs.2009.09.043) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Schematic demonstrations showing visceral debranching after Aorto-Bifemoral Bypass, followed by right limb to right renal and right superior mesenteric artery and left limb to left renal and common hepatic bypass. Copyright to the Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center. Journal of Vascular Surgery 2010 51, 259-266DOI: (10.1016/j.jvs.2009.09.043) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Schematic demonstrations showing arch and visceral debranching, inflow obtained from ascending aorta. Copyright to the Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center. Journal of Vascular Surgery 2010 51, 259-266DOI: (10.1016/j.jvs.2009.09.043) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Completion angiography after stent grafting in a patient that underwent arch and abdominal debranching shows the patency of bypass grafts and the exclusion on the aneurysm. Journal of Vascular Surgery 2010 51, 259-266DOI: (10.1016/j.jvs.2009.09.043) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 Mini Thoracotomy. A: Right anterolateral “mini” thoracotomy incision combined with supraclavicular incision and anteromedial sternocleidomastoid incison extension during arch debranching in a patient with previous sternotomy. B: Post operative picture shows healed incisions. Journal of Vascular Surgery 2010 51, 259-266DOI: (10.1016/j.jvs.2009.09.043) Copyright © 2010 Society for Vascular Surgery Terms and Conditions