Raghuveer Vallabhaneni, MD, Luis A. Sanchez, MD

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Presentation transcript:

Open techniques for arch vessel reconstruction during thoracic endovascular aneurysm repair (TEVAR) Raghuveer Vallabhaneni, MD, Luis A. Sanchez, MD Journal of Vascular Surgery Volume 52, Issue 4, Pages 71S-76S (October 2010) DOI: 10.1016/j.jvs.2010.06.146 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 A left subclavian-carotid bypass using polytetrafluoroethylene (PTFE) was done preoperatively in a patient with a thoracic aneurysm encroaching on the left subclavian artery. The subclavian artery was ligated and subsequent thoracic endovascular aneurysm repair (TEVAR) was performed to exclude the aneurysm. Journal of Vascular Surgery 2010 52, 71S-76SDOI: (10.1016/j.jvs.2010.06.146) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 A left dominant vertebral off the arch complicating a thoracic aneurysm. A, The left vertebral artery (arrow) is shown coming between the left common carotid (open arrow) and left subclavian artery (arrowhead) on an intraoperative angiogram. B, Selective angiogram of vertebal coming off arch. C, Postoperative angiogram after subclavian-carotid transposition and vertebral artery transpostition to left subclavian artery. Journal of Vascular Surgery 2010 52, 71S-76SDOI: (10.1016/j.jvs.2010.06.146) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Three-dimensional reconstructions of chest (A) and neck (B) of a patient with an aneurysm, which required endograft coverage of the left carotid artery. The patient underwent a preoperative right-to-left carotid-carotid bypass and left carotid-subclavian bypass with left carotid ligation and coil embolization of proximal carotid artery. Journal of Vascular Surgery 2010 52, 71S-76SDOI: (10.1016/j.jvs.2010.06.146) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Two-stage elephant trunk reconstruction. A, Magnetic resonance angiogram three-dimensional imaging after elephant trunk placement. B, Angiogram after second stage thoracic endograft deployment showing exclusion of aneurysm. Journal of Vascular Surgery 2010 52, 71S-76SDOI: (10.1016/j.jvs.2010.06.146) Copyright © 2010 Society for Vascular Surgery Terms and Conditions