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

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Presentation on theme: "A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach  Juan Carlos Jimenez, MD, Wesley."— Presentation transcript:

1 A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach  Juan Carlos Jimenez, MD, Wesley S. Moore, MD  Journal of Vascular Surgery  Volume 48, Issue 6, Pages (December 2008) DOI: /j.jvs Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

2 Fig 1 A computed tomography three-dimensional reconstruction of the patient's combined type A and B aortoiliac dissection before the hybrid repair. The innominate, left subclavian, left common carotid, celiac, superior mesenteric, left renal, and right iliac arteries arise from the true lumen. The right renal and left iliac arteries arise from the false lumen. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

3 Fig 2 Three-dimensional view of the patient's initial computed tomography following 180-degree rotation demonstrates the false lumen and its branches. The right renal and left iliac arteries arise from the true lumen. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

4 Fig 3 A computed tomography three-dimensional reconstruction after (1) repair of the aortic arch with elephant trunk procedure; (2) resection of the infrarenal abdominal aortic aneurysm and bilateral common iliac arteries and reconstruction with bifurcated Hemashield graft (Boston Scientific, Natick, Mass) to the iliac bifurcations; and (3) endograft placement in the true lumen of the descending thoracic aorta. Note that the celiac, superior mesenteric artery, and left renal arteries now arise from the false lumen after luminal shift secondary to endograft deployment. The diameter of the descending thoracic aorta increased in size from 4.6 to 6.1 cm in a 6-month period. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

5 Fig 4 Final three-dimensional reconstruction after the five-stage hybrid repair. The entire native aorta from root to bilateral iliac bifurcations has been replaced with graft or endovascular stent graft, or both. No neurologic complications were observed. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

6 Fig 5 Rotational view of the final three-dimensional reconstruction demonstrates a lateral view of the patent visceral bypass grafts to bilateral renal arteries, the celiac trunk, and the superior mesenteric artery. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

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