Hybrid Repair of Aortic Arch Aneurysms: A Totally Extrathoracic Approach with Branched Endografts in Two Patients

Ferreira, Marcelo; Chuter, Timothy A.M.; Hartley, David; Lanziotti, Luiz; Abuhadba, Giafar; Monteiro, Marcelo; Capotorto, Luis Fernando

doi:10.2310/6670.2007.00027

Cited by 12 publications

(6 citation statements)

References 11 publications

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“…7,9,[11][12][13][14][15][16][17][18][19][20] We share this opinion, having found that the use of available custommade branched stent grafts is feasible and can be offered as a safe, effective alternative for patients with TAAAs, especially for high risk patients with clinical comorbidities that would preclude open surgical procedures. aneurysms, and we deployed the bridging stent way down into these arteries.…”

Section: Discussionmentioning

confidence: 95%

Branched devices for thoracoabdominal aneurysm repair: Early experience

Ferreira¹,

Lanziotti²,

Monteiro³

2008

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 95%

Branched devices for thoracoabdominal aneurysm repair: Early experience

Ferreira¹,

Lanziotti²,

Monteiro³

2008

Journal of Vascular Surgery

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“…37 Ferreira, et al recognised the lack of an appropriate proximal landing zone of at least 2-3 cms required for endograft sealing and anchoring to reduce the risk of endoleaks and migration as the main difficulty in endovascular repair of arch aneurysms and reported two such cases treated with branched endografts with complete exclusion. 38 Our patient was not a candidate for the endovascular intervention in light of involvement of the entire aortic root, valve and arch.…”

Section: Discussionmentioning

confidence: 96%

Continuous selective bilateral antegrade cerebral perfusion through anomalous innominate artery for repair of root, ascending aortic and arch aneurysm – challenges, vagaries and opportunities of bovine arch variant anatomy and review of literature

et al. 2009

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We describe the repair of a root, ascending aortic and arch aneurysm in a 69-year-old man with a bioprosthetic Shelhigh conduit and cylinder, employing continuous bilateral antegrade cerebral perfusion through an anomalous innominate artery with a bovine arch variant anatomy. The origin of both the innominate artery and the left common carotid artery from a common stem from the arch in this bovine arch variant puts the whole cerebral circulation at risk, on one hand, yet provides an opportunity of continuous bilateral antegrade cerebral perfusion through the right brachial, right axillary, right subclavian or innominate artery, during arch reconstruction under lower body, deep hypothermic circulatory arrest. Safety and adequacy of selective cerebral perfusion through the right axillary artery in patients with normal arch vessel origin depends on an intact circle of Willis. In this bovine arch variant, both cerebral hemispheres can be perfused through the right brachial, right axillary, right subclavian or the innominate artery, independent of the integrity of the circle of Willis, because of the origin of the left common carotid artery from the innominate artery, except for the area supplied by the left vertebral artery. Although this is the first report of innominate artery perfusion for arch reconstruction for aneurysm in a bovine arch variant, we believe the method described has important implications for cerebral protection in light of the generally reported incidence of bovine arch from 13 to 35 percent.

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“…This is usually accomplished by open debranching or use of debranching devices, which are under investigation. 6,7 Fourth, significant atherosclerotic disease in the arch increases risk of stroke from particulate embolization during wire and device manipulation. Fifth, most of these devices require large size sheaths, which could pose a challenge in patients with tortuous and diseased iliac vessels or in young female patients.…”

Section: Discussionmentioning

confidence: 98%