Staged hybrid approach using proximal thoracic endovascular aneurysm repair and distal open repair for the treatment of extensive thoracoabdominal aortic.

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Presentation transcript:

Staged hybrid approach using proximal thoracic endovascular aneurysm repair and distal open repair for the treatment of extensive thoracoabdominal aortic aneurysms William F. Johnston, MD, Gilbert R. Upchurch, MD, Margaret C. Tracci, MD, Kenneth J. Cherry, MD, Gorav Ailawadi, MD, John A. Kern, MD Journal of Vascular Surgery Volume 56, Issue 6, Pages 1495-1502 (December 2012) DOI: 10.1016/j.jvs.2012.05.091 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 Approach to staged hybrid thoracic endovascular aneurysm repair (TEVAR)-open surgery (OS) repair for extensive thoracoabdominal aortic aneurysms. Three-dimensional reconstructions from computed tomography (CT) angiography are shown with sample cross-sectional CT images shown below, corresponding to the level of the white line in the aortic CT reconstructions. A, A patient presented with a 7.1-cm extent II thoracoabdominal aortic aneurysm secondary to a penetrating aortic ulcer that was treated initially with proximal TEVAR. B, Following TEVAR, the proximal aorta remodeled from 7.1 cm to 5.6 cm (cross-sectional image a). However, distal thoracic and abdominal aortic expansion occurred (cross-sectional image b), which was treated with open distal aortic repair (C). Journal of Vascular Surgery 2012 56, 1495-1502DOI: (10.1016/j.jvs.2012.05.091) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 Placement of thoracic endovascular aneurysm repair (TEVAR) from the left subclavian artery origin with persistent perfusion (white arrow) in the false lumen from a distal fenestration. Journal of Vascular Surgery 2012 56, 1495-1502DOI: (10.1016/j.jvs.2012.05.091) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 Staged hybrid approach. A, Distal thoracic aorta is represented with endograft in the true lumen and thrombus/debris in the false lumen. B, The thrombus/debris is removed from the false lumen, dissection septum is divided, and the aortic wall is cut along the red dashed line to taper the aortic wall. C, The anastomosis is made with an end-to-end attachment of the endograft, tapered aortic wall, and felt reinforcement to the prosthetic graft. Journal of Vascular Surgery 2012 56, 1495-1502DOI: (10.1016/j.jvs.2012.05.091) Copyright © 2012 Society for Vascular Surgery Terms and Conditions