Combined Surgical and Endovascular Repair of Complex Aortic Pathologies With a New Hybrid Prosthesis Michael Gorlitzer, MD, Gabriel Weiss, MD, Markus.

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Combined Surgical and Endovascular Repair of Complex Aortic Pathologies With a New Hybrid Prosthesis Michael Gorlitzer, MD, Gabriel Weiss, MD, Markus Thalmann, MD, Gerard Mertikian, MD, Wojciech Wislocki, MD, Johann Meinhart, PhD, Ferdinand Waldenberger, MD, Martin Grabenwoger, MD The Annals of Thoracic Surgery Volume 84, Issue 6, Pages 1971-1976 (December 2007) DOI: 10.1016/j.athoracsur.2007.07.010 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The E-vita open endoluminal stent graft (Jotec Inc, Hechingen, Germany). (Left) Deployed stent graft with its Dacron prosthesis at the proximal end. (Right) Closed device with stiff guidewire. The Annals of Thoracic Surgery 2007 84, 1971-1976DOI: (10.1016/j.athoracsur.2007.07.010) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative photographs (a and b) show placement of the stent graft (Jotec Inc, Hechingen, Germany) into the descending aorta. The Dacron graft is pulled out to perform a hemiarch and ascending aortic repair (c and d). The Annals of Thoracic Surgery 2007 84, 1971-1976DOI: (10.1016/j.athoracsur.2007.07.010) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (a) “Light” arch replacement performing an anastomosis with the proximal descending aorta with the Dacron graft (Jotec Inc, Hechingen, Germany) using a running mattress suture and placement of the stent graft to the descending aorta. The brachiocephalic trunk was perfused via the right subclavian artery, and a selective perfusion catheter was installed into the left carotid artery for cerebral protection. The left subclavian artery was blocked by a catheter with an inflatable balloon. (b) Thereafter, a separate prosthesis (Vascutek Terumo, Renfrewshire, Scotland, Great Britain) was anastomosed to the concavity of the remaining arch. The Annals of Thoracic Surgery 2007 84, 1971-1976DOI: (10.1016/j.athoracsur.2007.07.010) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Computed tomography scans show the stent graft. The prosthesis replaces the ascending aorta and the stent graft is placed within the proximal descending aorta (left). Note complete thrombosis of the perigraft space (right). The Annals of Thoracic Surgery 2007 84, 1971-1976DOI: (10.1016/j.athoracsur.2007.07.010) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Consecutive stent grafting of the descending aorta after replacement of the aortic arch and proximal descending aorta by light aortic arch repair using hybrid prosthesis. The Annals of Thoracic Surgery 2007 84, 1971-1976DOI: (10.1016/j.athoracsur.2007.07.010) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions