Clinical results of open stent grafting applied using an improved endotracheal tube in the treatment of high-risk patients with distal arch aneurysms

Abstract

Whereas the operative results for thoracic aortic aneurysms (TAA) have improved in recent years, the results for distal arch aneurysms (DAA) remain unsatisfactory. We report herein the initial results of open stent grafting (OSG) applied using an improved endotracheal tube for surgical treatment of high-risk DAA. OSG was used to treat DAA in five men aged 69-80 years (mean, 77 years). Four cases involved chronic obstructive pulmonary disease, and the remaining case involved both ischemic heart disease and chronic renal failure. Previous surgical repairs of an abdominal aortic aneurysm had been performed in four patients, and thoracoplasty and reconstruction of the lower extremities had been performed in the remaining patient. Under selective cerebral perfusion, OSG with revascularization of two cerebral branches was performed in two patients, whereas OSG with total arch replacement was performed in three patients. The procedure was successful in all cases. There were no complications related to cerebrospinal disorders, and complete thrombosis of the aneurismal sac was achieved in all cases. The new deployment method using an endotracheal tube offers numerous advantages, including reduced aortic wall injury and accurate placement of the stent graft in the operative field. These initial results suggest that this specific approach makes OSG a useful surgical procedure in the treatment of high-risk DAA.

Long-Term Results of Open Stent-Grafting Using a Matsui-Kitamura Stent to Treat Thoracic Aortic Aneurysm

“…are inflexible, in extended TAA surgery, two or three such stents (50-75 mm) are inserted at the end of the graft to follow the aortic curve; other segments of the graft are not supported by the stent. [3][4][5][6][7] Complications may arise if the graft becomes twisted at insertion, a flexed stent is placed in a curve, or the terminal end of the stent migrates because of changes in the aneurysm over time. 6) The MK stent used in our series is flexible and easy to place, and it extends along and supports the full length of the graft.…”

“…The likelihood of phrenic or recurrent laryngeal nerve injury is thereby decreased, and the risk of postoperative pulmonary complications may also be reduced. [4][5][6][7] However, the basic frames of most devices used in OSG have a Z configuration, which may not provide maximal…”

Fully supported open stent grafting applied with a Matsui-Kitamura (MK) stent in treatment of distal arch aneurysm

“…[3][4][5][6][7][8][9][10][11] In addition to accurate and safe placement methods, development of a superior SG to improve outcomes in distant grafting is of importance. The current Z stent is infl exible, 17,18 and therefore in DAA surgery two or three (50-75 mm) Z stents are inserted at the graft terminus to follow the curve, but other regions 13,14 We developed an MK stent that is fl exible, covers the full length of the graft, and is easy to place.…”

“…1,2 Open stent grafting (OSG) 3 is now commonly used as a new surgical technique to repair a DAA under short-term circulatory arrest via a median sternotomy by using a stent graft (SG). [4][5][6][7][8][9][10][11] However, this surgery requires placement of a large-diameter SG beyond the aortic bend in a narrow operative fi eld, which can result in complications of aortic dissection and embolism. 12 However, treatment of DAA using a SG with a basic Z stent, which is fi xed only at a distal point to adapt to bending, may cause fl exural deformation and stent breakage from the shrunken aneurysm.…”