Transapical Endovascular Stenting of Penetrating Atherosclerotic Ulcer of Ascending Aorta Utz Kappert, MD, Tamer Ghazy, MD, Ahmed Ouda, MD, Ralf-Thorsten.

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Transapical Endovascular Stenting of Penetrating Atherosclerotic Ulcer of Ascending Aorta Utz Kappert, MD, Tamer Ghazy, MD, Ahmed Ouda, MD, Ralf-Thorsten Hoffmann, MD, Gregor Simonis, MD, Klaus Matschke, MD The Annals of Thoracic Surgery Volume 96, Issue 4, Pages e101-e103 (October 2013) DOI: 10.1016/j.athoracsur.2013.03.106 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative computed tomographic angiographic imaging (A) with three-dimensional reconstruction (B) showing the increased total diameter of the ascending aorta, the true lumen (1), extravasation of the radiocontrast agent (2, 5), extensive intramural hematoma (3), and the massive proximal calcification of the aortic arch, especially at the origin of the brachiocephalic trunk (4). The Annals of Thoracic Surgery 2013 96, e101-e103DOI: (10.1016/j.athoracsur.2013.03.106) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 6-Month follow-up computed tomographic angiographic imaging (A) with three-dimensional reconstruction (B) after initial successful restenting showing a persistent type Ib endoleak in axial view (1) and in the three-dimensional reconstruction (2). The Annals of Thoracic Surgery 2013 96, e101-e103DOI: (10.1016/j.athoracsur.2013.03.106) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Intraoperative image showing the excision of the ascending aorta with both stents in toto. Notice the thickened aortic wall, the position of the type Ib endoleak on the lesser curvature (A), and the different structure of the distal end to the proximal end of the primary stent after its shortening (B). The Annals of Thoracic Surgery 2013 96, e101-e103DOI: (10.1016/j.athoracsur.2013.03.106) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions