Sternotomy extra-anatomic bypass followed by stent-graft extraction

There's more than one way to skin this cat

“…Aortic segmental replacement with endograft extraction is generally preferred. In their Letter to the Editor, Dr Lick and colleagues 4 present an appealing strategy for off-pump extra-anatomic aortic bypass and resection of the diseased aortic segment combined with stent graft extraction. However, in moribund or highly frail patients, the approach proposed in our case may be considered because leaving the endograft may not necessarily predict poor outcomes when other treatment goals are met.…”

Sternotomy extra-anatomic bypass for stent-graft extension

“…I read with interest the letter to the Editor submitted by Lick and colleagues 1 in response to the manuscript entitled “Aorto-esophageal fistula resulting from aortic endograft migration” by Fernandez and colleagues 2 and its accompanying editorial. 3 Contained within the letter is an elegant description of the use of ascending aorta to supraceliac aorta extra-anatomic bypass performed via median sternotomy before posterolateral thoracotomy and resection of the graft, infected aorta, and involved surrounding tissue.…”

“…As stated by the authors, the use of 2 separate surgical fields allows for sterility of the extra-anatomic bypass, there is no need for cardiopulmonary bypass or hypothermic arrest, and “since the descending aorta is excluded proximally and distally, the stent-graft removal is simplified, and the surgeon can concentrate on field debridement, including en-bloc resection of lung or esophagus as needed.” 1 …”