A new staged hybrid total arch repair procedure using a branched proximal elephant trunk technique with implantation of stent grafts to the ascending.

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A new staged hybrid total arch repair procedure using a branched proximal elephant trunk technique with implantation of stent grafts to the ascending.

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Presentation transcript:

A new staged hybrid total arch repair procedure using a branched proximal elephant trunk technique with implantation of stent grafts to the ascending aorta Yoshiki Watanabe, MD, Kazuo Shimamura, MD, PhD, Yukitoshi Shirakawa, MD, PhD, Kei Torikai, MD, PhD, Toru Kuratani, MD, PhD, Yoshiki Sawa, MD, PhD Journal of Vascular Surgery Volume 58, Issue 6, Pages 1700-1704 (December 2013) DOI: 10.1016/j.jvs.2013.05.044 Copyright © 2013 Terms and Conditions

Fig 1 The preoperative computed tomography angiogram revealed an extended aortic arch aneurysm with an ascending aortic diameter of 50 mm and a distal arch aortic diameter of 70 mm. A, A three-dimensional reconstruction image. B, Sagittal view shows the aortic arch. Axial views are shown at the (C) level of the maximum aortic diameter and at the (D) level of the aortic arch. Journal of Vascular Surgery 2013 58, 1700-1704DOI: (10.1016/j.jvs.2013.05.044) Copyright © 2013 Terms and Conditions

Fig 2 A double-barrel tube graft was made of two graft components: a ringed Gore-Tex 12-mm graft (W. L. Gore & Associates) was used for the branch graft and a 28-mm Triplex graft (Vascutek Terumo) made of Dacron (DuPont) was used for the main graft. Radiopaque markers were placed at the distal rim of each graft and at the bifurcation. Journal of Vascular Surgery 2013 58, 1700-1704DOI: (10.1016/j.jvs.2013.05.044) Copyright © 2013 Terms and Conditions

Fig 3 Diagrams show the procedure. A, An aortic aneurysm extends from the ascending aorta to the descending aorta. B, The double-barreled tube graft is inserted into the ascending aorta. C, The right subclavian artery is connected to the left common carotid artery and the left subclavian artery with a ringed Gore-Tex 8-mm bifurcated graft (W. L. Gore & Associates). D, Stent grafting from the double-barreled tube graft to the descending aorta and brachiocephalic artery. Journal of Vascular Surgery 2013 58, 1700-1704DOI: (10.1016/j.jvs.2013.05.044) Copyright © 2013 Terms and Conditions

Fig 4 Intraoperative angiography revealed good blood flow into the brachiocephalic artery through the branch graft. The extended aortic aneurysms were completely excluded from the circulation. Journal of Vascular Surgery 2013 58, 1700-1704DOI: (10.1016/j.jvs.2013.05.044) Copyright © 2013 Terms and Conditions

Fig 5 The postoperative computed tomography angiogram revealed well-preserved cervical bypass flows and complete exclusion of the aortic aneurysms, with no endoleak. A, A three-dimensional reconstruction image. B, Sagittal view of the aortic arch. Axial views are shown (C) at the level of maximum aortic diameter and (D) at the level of the aortic arch. Journal of Vascular Surgery 2013 58, 1700-1704DOI: (10.1016/j.jvs.2013.05.044) Copyright © 2013 Terms and Conditions