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Distal Landing Zone Open Fenestration Facilitates Endovascular Elephant Trunk Completion and False Lumen Thrombosis  Eric E. Roselli, MD, Edgardo Sepulveda,

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Presentation on theme: "Distal Landing Zone Open Fenestration Facilitates Endovascular Elephant Trunk Completion and False Lumen Thrombosis  Eric E. Roselli, MD, Edgardo Sepulveda,"— Presentation transcript:

1 Distal Landing Zone Open Fenestration Facilitates Endovascular Elephant Trunk Completion and False Lumen Thrombosis  Eric E. Roselli, MD, Edgardo Sepulveda, MD, Akshat C. Pujara, BA, Jahanzaib Idrees, BS, Edward Nowicki, MD  The Annals of Thoracic Surgery  Volume 92, Issue 6, Pages (December 2011) DOI: /j.athoracsur Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Endovascular controversy in the treatment of chronic dissection with aneurysm: thromboexclusion of the false lumen is unpredictable because of retrograde filling and continued pressurization (arrows). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Distal landing zone open fenestration procedure. (A) Heart retracted cephalad to expose distal descending aorta through posterior pericardium or left pleural space. (B) Dissection flap excised through anterior longitudinal aortotomy. Intraoperative view of chronic dissection flap through aortotomy before (blue arrow in B) and after (blue arrow in C) open fenestration. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Chronic aorta with aneurysm after first-stage repair. The arrow in the illustration in panel (A) marks planned distal landing zone for second-stage endovascular completion. Axial computed tomographic scan of modified distal landing zone preoperatively (B) and postoperatively (C). Note the radiopaque metallic clip marking the modified distal landing zone. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 (A) Illustration and (B) volume-rendered computed tomography scan demonstrating completed 2-stage repair with stent graft spanning from elephant trunk to modified distal landing zone with complete circumferential seal to adventitia and exclusion of retrograde false lumen filling. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Estimated survival at median follow-up of 24 months.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

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