Aneurysms of the innominate artery: surgical treatment of 27 patients. John D. Symbas, M.D., Michael E. Joseph B. Whitehead Department of Surgery, Division.

Slides:

Advertisements

Similar presentations

Aortic Pathology Angioclub Case Alex Copelan M.D. William Beaumont Hospital October 24, 2013.

Advertisements

(1) Arch Debranching vs. Elephant Trunk for Hybrid Repair of the Proximal Thoracic Aorta Arch Debranching versus Elephant Trunk Procedures for Hybrid Repair.

Background (1) ・ In 1998, we developed a modified elephant trunk (ET) technique using a single four-branched arch graft with a sewing “collar” and “long.

Thoracic aortic disease Kittichai Luengtaviboon 21 January 2011.

Optimal Graft Diameter and Location Reduces Postoperative Complications Following Total Arch Replacement with a Long Elephant Trunk K. Taniguchi K.Toda.

Antegrade Stent Grafting of Descending Thoracic Aorta During Acute Debakey I Dissection: Early and Midterm Outcomes Prashanth Vallabhajosyula MD, Joseph.

Results of “Type II” Hybrid Arch Repair with Zone 0 Stent Graft Deployment Jehangir Appoo, William Kent, Eric Herget, Jason Wong, Alberto Pochettino and.

ANESTHESIA FOR AORTIC SURGERY By: DR. Ahmed Mostafa Assist. Prof. of anesthesia Benha faculty of medicine.

Aortic Aneurysms Dilshan Udayasiri. Some Anatomy ascending aorta arch of the aorta descending aorta abdominal aorta.

Nadeen mohamed mamdouh Habib

Vascular Rings & Sling Seoul National University Hospital

Without Deep Hypothermia

Sakakibara Heart Institute Minoru Tabata, MD, MPH, Akihito Matsushita, MD, Toshihiro Fukui, MD, Shigefumi Matsuyama, MD, Tomoki Shimokawa, MD, Shuichiro.

Usefulness of fenestrated stent graft for thoracic aortic aneurysms

Osaka University Department of Cardiovascular Surgery Osaka University Department of Cardiovascular Surgery The efficacy of debranching TEVAR for arch.

Pre-operative Cerebral Malperfusion in Patients with Acute Type A Aortic Dissection Involving the Supra-aortic Branches: Treatment and Early Outcome Maximilian.

Management of Iliac Artery Aneurysms. Etiology Idiopathic – Remote collagen vascular disease Idiopathic – Remote collagen vascular disease Atherosclerosis,

One-stage repair for Stanford Type B Aortic Dissection concomitant with cardiac diseases Open stented elephant trunk technique combined with cardiac operation.

Tenri Hospital Dept. Cardiovascular Surgery Tenri Hospital, Dept. of Cardiovascular Surgery Daisuke Nakatsuka, M.D. Kazuo Yamanaka, M.D., Ph.D. Acute Type.

Aneurysm. It is a blood sac that communicates with the lumen of an artery They are classified according to –Etiology congenital Acquired –pathological,

PREDICTORS FOR IN HOSPITAL MORTALITY IN PATIENTS WITH TYPE A AORTIC DISSECTION FROM A TWO CENTRE EXPERIENCE S Leontyev, J Légaré, MA Borger, K Buth, AK.

The Reoperative Aortic Root: Degenerative Failure vs. Infectious Destruction – Outcomes of The “True Redo-Root” Reconstruction Rita K. Milewski, Arminder.

Imaging Experience of Type II Hybrid Aortic Arch Repair: Lessons learned from Zone 0 Debranching & Evolution to Zone 2 Arch Repair Vamshi Kotha, Eric J.

Peripheral Vascular Disease

Hybrid Arch for Acute Type A Aortic Dissection

Hybrid Arch for Acute Type A Aortic Dissection

Shunji Sano, MD, Kozo Ishino, MD, Masaaki Kawada, MD, Osami Honjo, MD

LEFT SUBCLAVIAN ARTERY REVASCULARIZATION DURING DEBRANCHING PROCEDURE FOR ACUTE “TYPE A“ AORTIC DISSECTION USING THE LEFT INTERNAL MAMMARY ARTERY Thank.

Illustration of the reversed elephant trunk technique using a traditional “island” approach to total aortic arch replacement. A. Stage 1: The distal aorta.

Open Repair of Distal Aortic Arch and Proximal Descending Thoracic Aortic Aneurysm Using a Stepwise Distal Anastomosis Hitoshi Ogino, MD Operative Techniques.

Brain and spinal cord protection during simultaneous aortic arch and thoracoabdominal aneurysm repair Gottfried Mommertz, MD, Stephan Langer, MD, Thomas.

Aortic arch repair in children with PHACE syndrome

Technique for Managing Tracheo-Innominate Artery Fistula

Use of custom Dacron branch grafts for “hybrid” aortic debranching during endovascular repair of thoracic and thoracoabdominal aortic aneurysms G. Chad.

Open Repair of Distal Aortic Arch and Proximal Descending Thoracic Aortic Aneurysm Using a Stepwise Distal Anastomosis Hitoshi Ogino, MD Operative Techniques.

Shunji Sano, MD, Kozo Ishino, MD, Masaaki Kawada, MD, Osami Honjo, MD

A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without.

The “first generation” of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta Michael D. Dake, MD, D.Craig Miller,

Anatomic Repair of Recurrent Aortic Arch Obstruction

Surgical Correction of Diffuse Supravalvular Aortic Stenosis Involving the Branches of the Aortic Arch Gideon Merin, M.D., Isac J. Copperman, M.D., Joseph.

Hybrid thoracic endovascular aortic repair: Pushing the envelope

Joseph S. Coselli, MD, Peter Oberwalder, MD

Hemi-Fontan Procedure

Raghuveer Vallabhaneni, MD, Luis A. Sanchez, MD

Paul P. Urbanski, MD, PhD, Vadim Irimie, MD, Lukas Lehmkuhl, MD, PhD

Nicholas D. Andersen, MD, Michael E. Barfield, MD, Jennifer M

The Reversed Elephant Trunk Technique Used for Treatment of Complex Aneurysms of the Entire Thoracic Aorta Joseph S. Coselli, MD, Scott A. LeMaire, MD,

Hybrid repair of an aortic arch aneurysm with complex anatomy: Right aortic arch and anomalous origin of supra-aortic vessels Roberto Chiesa, MD, Germano.

Extended aortic replacement for acute type a dissection with the tear in the descending aorta Terushisa Kazui, MD, Yukihiko Tamiya, MD, Toshiaki Tanaka,

Clinical outcomes and rates of aortic growth and reoperation after 1-stage repair of extensive chronic thoracic aortic dissection Nicholas T. Kouchoukos,

Joseph S Coselli, Luiz F.Poli de Figueiredo, Scott A LeMaire

Aortic coarctation in the adult: Management of complications and coexisting arterial abnormalities with hypothermic cardiopulmonary bypass and circulatory.

Retrograde segmental aortic repair for type II thoracoabdominal aortic aneurysm Teruhisa Kazui, MD, Katsushi Yamashita, MD, Hitoshi Terada, MD, Naoki.

Perfusion and repair technique in acute aortic dissection with cerebral malperfusion and damage of the innominate artery Paul P. Urbanski, MD, PhD, Matthias.

Pan-aortic hybrid treatment of mega-aorta syndrome

Anthony L. Estrera, MD, Charles C

Vascular Surgery Michael Ricci, MD.

Advantages of the continuous telescopic inversion technique do not overcome the disadvantages of the “turn-up” technique of aortic anastomosis Takeshi.

Primary aortoesophageal fistula from aortic aneurysm: Successful surgical treatment by use of omental pedicle graft Joseph S. Coselli, MD, E.Stanley.

The frozen elephant trunk technique: A new treatment for thoracic aortic aneurysms Matthias Karck, MD, Ajay Chavan, MD, Christian Hagl, MD, Holger Friedrich,

Surgical Treatment of Aortic Arch Aneurysms in Profound Hypothermia and Circulatory Arrest Martin Grabenwöger, Marek Ehrlich, Fabiola Cartes-Zumelzu,

Intimal intussusception: Unusual complication of dissecting aneurysm

Optimal graft diameter and location reduce postoperative complications after total arch replacement with long elephant trunk for arch aneurysm Haruhiko.

Hybrid Repair of an Aortic Arch Aneurysm Using Double Parallel Grafts Perfused by Retrograde Flow in Endovascular Repair Combined With Left Subclavian.

Arch-first technique for aortic arch aneurysm repair through median sternotomy Motonobu Nishimura, MD, Shigeaki Ohtake, MD, Yoshiki Sawa, MD, Toshiki.

A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach Juan Carlos Jimenez, MD, Wesley.

David Spielvogel, MD, James C

Christo I. Tchervenkov, MD, Stephen J

Presentation transcript:

Aneurysms of the innominate artery: surgical treatment of 27 patients. John D. Symbas, M.D., Michael E. Joseph B. Whitehead Department of Surgery, Division of Cardiovascular Surgery, Grady Memorial Hospital. J Card Surg 2005;20:455~459

Introduction Aneurysms of the innominate artery (AIA) are widely considered to be a rare entity. We describe our experience with AIAs in the last three decades.

Methods From October 1973 to October 2000, 27 patients were operated with an AIA. The underlying cause of aneurysm was Takayasu's disease in 7 patients, degenerative disease in 6 patients, syphilis in 5 patients, chronic dissection in 3 patients, trauma in 2 patients, infection in 2 patients, a postoperative complication in 1 patient, and Marfan ’ s syndrome in 1 patient. AIA was associated with an aortic aneurysm in 17 patients.

Fourteen patients had no symptoms. The remaining patients had symptoms, with thromboembolic complications in 7 patients, pain without rupture in 3 patients, and a ruptured aneurysm in 3 patients.

In two patients at high risk for surgery who had a small AIA with embolic complications, a cervical approach was used as a means of performing distal exclusion and crossover bypass. In the remaining 25 patients, a midline sternotomy was used.

Ten patients underwent a prosthetic replacement of the ascending aorta and/or aortic arch with a separate prosthetic branch to the innominate artery (IA). Thirteen patients underwent ascending aorta- to-IA prosthetic bypass in association with lateral suture (8 patients) or prosthetic patching (5 patients) of the aorta.

One patient with an infected aneurysm was treated by means of resection of the aneurysm, proximal ligation of the IA, and transposition of the right into the left common carotid artery. Cardiopulmonary bypass with deep hypothermic circulatory arrest was used in 10 patients.

Results Three perioperative deaths occurred (2 of 4 in association with emergency treatment and 1 of 23 with elective treatment). Respiratory complications requiring prolonged artificial ventilation developed in five patients. Two patients had transient worsening of preoperative neurologic deficits. Late results, with a mean follow-up of 85 months, were good.

Conclusion The etiology and presentation of AIAs are variable. In approximately 85% of the cases, the rupture occurs in the proximal segment of the artery, while 9% occur in the distal segment, and 3% occur in the middle segment.

The patients with an isolated innominate artery injury should undergo prompt operative repair. Median sternotomy is the incision of choice for the repair of rupture with or without extension along the lower anterior border of the right sternocledomastoid muscle. Graft interposition between the ascending aorta and the distal innominate artery or right common carotid and right subclavian arteries is a safer approach for this injury.

Prompt surgical treatment including resection of the aneurysm and adjacent necrotic tissue and bypass grafting to a distal vessel is indicated to minimize the risk of distal embolization or rupture. Surgical management with current cardiovascular techniques achieves excellent results.