Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports

Traditional repair of aortic arch aneurysms requires cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest - allowing detachment of the head vessels off the aneurysm, and their anastomosis onto the graft. The procedure is safe and reproducible, however morbidity is signi...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	D.G. Harris, A. Saaiman, D. du Toit, G. Rossouw
Formato:	article
Lenguaje:	EN
Publicado:	South African Heart Association 2017
Materias:	aortic arch endovascular repair Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/4e2fbb5bb1754e1c85bb3a6c6847bba8
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:4e2fbb5bb1754e1c85bb3a6c6847bba8
record_format	dspace
spelling	oai:doaj.org-article:4e2fbb5bb1754e1c85bb3a6c6847bba82021-11-26T13:25:54ZMinimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports10.24170/7-3-19461996-67412071-4602https://doaj.org/article/4e2fbb5bb1754e1c85bb3a6c6847bba82017-04-01T00:00:00Zhttps://www.journals.ac.za/index.php/SAHJ/article/view/1946https://doaj.org/toc/1996-6741https://doaj.org/toc/2071-4602Traditional repair of aortic arch aneurysms requires cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest - allowing detachment of the head vessels off the aneurysm, and their anastomosis onto the graft. The procedure is safe and reproducible, however morbidity is significant and includes air embolism, stroke, excessive bleeding and acidosis. In addition the procedures are time-consuming, and cardioplegic arrest is also necessary, resulting in the potential for low cardiac output. Aortic arch aneurysms are not typically suitable for endovascular intervention. With improving techniques of descending aortic repair with stent grafts, hybrid techniques, which involve aortic arch debranching - thereby creating a proximal landing zone of adequate length, followed by stenting over the aortic arch are becoming popular. Methods: Four cases are presented. The technique involves initial sternotomy or upper sternal split, detachment of the innominate and left common carotid arteries, and their reattachment to the ascending aorta by separate grafts (debranching procedure). During this time a side clamp is placed on the ascending aorta. The left subclavian is usually left intact for technical reasons, unless there is a dominant left vertebral artery. This is safe as the shoulder has adequate collateral circulation, and stenting over this vessel is therefore well tolerated. The aortic arch is then completely covered with a stent graft which is inserted via the femoral artery. Arteriography was performed at the end of the procedure to confirm stent graft position and exclusion of the lesion. Results: All surgical transpositions were successful, and the patients recovered without neurologic, bleeding or cardiac complications. Surgical conversion for aortic graft was never required. There were no endoleaks. Mean duration of follow up was 53.5 months (range 21-77). Conclusions: Endovascular repair of the descending thoracic aorta, initially reserved for inoperable patients, is now becoming the accepted initial management. With improved technology and endografts it is now the safest option, especially for traumatic dissection. These techniques have now extended to the aortic arch. Debranching of the aortic arch enables endovascular grafting in this area, thereby avoiding cardiopulmonary bypass and circulatory arrest. Good pre-operative planning is necessary to make the procedure feasible.D.G. HarrisA. SaaimanD. du ToitG. RossouwSouth African Heart Associationarticleaortic archendovascular repairDiseases of the circulatory (Cardiovascular) systemRC666-701ENSA Heart Journal, Vol 7, Iss 3, Pp 172-179 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	aortic arch endovascular repair Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	aortic arch endovascular repair Diseases of the circulatory (Cardiovascular) system RC666-701 D.G. Harris A. Saaiman D. du Toit G. Rossouw Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports
description	Traditional repair of aortic arch aneurysms requires cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest - allowing detachment of the head vessels off the aneurysm, and their anastomosis onto the graft. The procedure is safe and reproducible, however morbidity is significant and includes air embolism, stroke, excessive bleeding and acidosis. In addition the procedures are time-consuming, and cardioplegic arrest is also necessary, resulting in the potential for low cardiac output. Aortic arch aneurysms are not typically suitable for endovascular intervention. With improving techniques of descending aortic repair with stent grafts, hybrid techniques, which involve aortic arch debranching - thereby creating a proximal landing zone of adequate length, followed by stenting over the aortic arch are becoming popular. Methods: Four cases are presented. The technique involves initial sternotomy or upper sternal split, detachment of the innominate and left common carotid arteries, and their reattachment to the ascending aorta by separate grafts (debranching procedure). During this time a side clamp is placed on the ascending aorta. The left subclavian is usually left intact for technical reasons, unless there is a dominant left vertebral artery. This is safe as the shoulder has adequate collateral circulation, and stenting over this vessel is therefore well tolerated. The aortic arch is then completely covered with a stent graft which is inserted via the femoral artery. Arteriography was performed at the end of the procedure to confirm stent graft position and exclusion of the lesion. Results: All surgical transpositions were successful, and the patients recovered without neurologic, bleeding or cardiac complications. Surgical conversion for aortic graft was never required. There were no endoleaks. Mean duration of follow up was 53.5 months (range 21-77). Conclusions: Endovascular repair of the descending thoracic aorta, initially reserved for inoperable patients, is now becoming the accepted initial management. With improved technology and endografts it is now the safest option, especially for traumatic dissection. These techniques have now extended to the aortic arch. Debranching of the aortic arch enables endovascular grafting in this area, thereby avoiding cardiopulmonary bypass and circulatory arrest. Good pre-operative planning is necessary to make the procedure feasible.
format	article
author	D.G. Harris A. Saaiman D. du Toit G. Rossouw
author_facet	D.G. Harris A. Saaiman D. du Toit G. Rossouw
author_sort	D.G. Harris
title	Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports
title_short	Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports
title_full	Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports
title_fullStr	Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports
title_full_unstemmed	Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports
title_sort	minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports
publisher	South African Heart Association
publishDate	2017
url	https://doaj.org/article/4e2fbb5bb1754e1c85bb3a6c6847bba8
work_keys_str_mv	AT dgharris minimallyinvasivesurgerytotheaorticarchendovascularrepaircombinedwithdebranching4casereports AT asaaiman minimallyinvasivesurgerytotheaorticarchendovascularrepaircombinedwithdebranching4casereports AT ddutoit minimallyinvasivesurgerytotheaorticarchendovascularrepaircombinedwithdebranching4casereports AT grossouw minimallyinvasivesurgerytotheaorticarchendovascularrepaircombinedwithdebranching4casereports
_version_	1718409288898052096

Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports

Ejemplares similares