Distal arch aneurysm repair using stent-grafting and ascending aorto-left axillary bypass Yukinori Moriyama, MD, Yoshifumi Iguro, MD, Koichi Hisatomi,

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Distal arch aneurysm repair using stent-grafting and ascending aorto-left axillary bypass Yukinori Moriyama, MD, Yoshifumi Iguro, MD, Koichi Hisatomi, MD, Riichiro Toda, MD, Goichi Yotsumoto, MD The Annals of Thoracic Surgery Volume 70, Issue 6, Pages 1974-1976 (December 2000) DOI: 10.1016/S0003-4975(00)02161-5

Fig 1 Preoperative and postoperative imaging study (patient 3). Preoperative aortography (A) revealed a saccular aneurysm in the distal aortic arch (arrows). Postoperative aortography (B) and computed tomography (CT) (C) taken 2 weeks after the repair demonstrated complete obliteration of aneurysm filling and extraanatomic bypass graft between the ascending aorta and the left subclavian artery (arrows). Follow-up CT (D) taken 4 months after the repair demonstrated reduction of aneurysm size and no endoleaks from intercostal artery. The Annals of Thoracic Surgery 2000 70, 1974-1976DOI: (10.1016/S0003-4975(00)02161-5)

Fig 2 Semiflexible stent-graft and applicator. A middle segment of the prosthetic graft was free of stent to maintain its flexibility to fit the curvature of the distal aortic arch (A). The stent-graft was introduced into an applicator prepared from a syringe with the tip of its outer barrel cut (B). The Annals of Thoracic Surgery 2000 70, 1974-1976DOI: (10.1016/S0003-4975(00)02161-5)