Banding Technique for Endovascular Repair of Arch Aneurysm With Unsuitable Proximal Landing Zone

Abstract

Endovascular repair of thoracic aortic aneurysms is an attractive alternative to surgical graft replacement, but many patients are excluded because of unsuitable proximal landing zones wider than 38 mm in diameter. Arch aneurysms can be repaired with less invasive hybrid surgery, combining endovascular stent grafting with banding of the proximal landing aorta. Since November 2006, 6 of 88 patients underwent hybrid aortic arch repair with presumptive zone 0 as the proximal landing site where the median maximal diameter was 42.5 mm (from 39 to 44 mm). After partial sternotomy, relocation of the supra-aortic branches, the ascending aorta was banded with a 2-layer Dacron strip and reduced to 36+/-1 mm in diameter where the stent graft was inserted and incorporated securely. All patients were uncomplicated, with complete exclusion of the arch lesion and without endoleaks or migration during an average 9 months' follow-up. Secure fixation of an unsuitable ascending aorta can be solved via aortic banding and will not only improve the short-term stability of the endovascular intervention, but may become the preferred therapeutic modality in patients with multiple comorbidities.