Endovascular stent-grafting via the aortic arch for distal aortic arch XXXX : an alternative to endovascular stent-grafting.

@entity1 @entity1070 @entity439 @entity1167 @entity1856 @entity451 @entity1580 @entity385
OBJECTIVE: We have experienced transaortic stent-grafting for treating distal arch @entity439 or type B dissection. This paper is to mainly report the surgical aspect of these procedures. METHODS: Fifteen @entity1 underwent this surgery, including 12 @entity1 and three @entity1 ranging from 47 to 83 years. Twelve had @entity439 and three @entity1580 . Concomitant surgery was necessary in seven @entity1 (coronary artery bypass grafting in five, tricuspid annuloplasty in one, and replacement of ascending aorta and/or total arch replacement in three cases). A stent graft (Gianturco Z-stent and Intervascular prosthesis) was loaded in a 30-F sheath catheter. Under @entity1167 , selective cerebral perfusion was established, and the sheath catheter was inserted through aortotomy into descending aorta and the stent graft was deployed at an appropriate level. The proximal end of graft was sutured to the aorta just distal to the left subclavian artery with inclusion method at the posterior wall. Concomitant surgery was done during cooling or rewarming period. TEE was utilized to visualize every endovascular manipulation to avoid unintended intimal injury or misplacement of graft and to assess the surgical results in the operative theater. RESULTS: @entity439 was successfully excluded except in one @entity1 who had a proximal @entity1070 and @entity1070 due to underestimation of aortic diameter. There was one operative mortality caused by @entity385 , possibly due to debris from femoral arterial cannulation. In the remaining @entity1 , there was no enlargement of residual @entity439 . The excluded aneurysmal sac gradually regressed and disappeared within 2 years in five @entity1 and the thrombosed false lumen completely shrunk within 1 year in two @entity1 . One @entity1 had @entity451 , possibly because the graft was intentionally advanced deeply to cover the thick and fragile @entity1856 layer in order to avoid destruction of the @entity1856 by an expanded graft. CONCLUSIONS: Endovascular stent graft via the aortic arch is an acceptable treatment for distal arch @entity439 close to or involving left subclavian artery or type B dissections, especially for those cases requiring other cardiac procedures. It can lead to regression and disappearance of @entity439 or dissection in the mid-term follow-up.
