The Arch-First Technique for Complex Arch and Proximal Descending Aortic Aneurysms

Abstract

Aneurysms involving both the aortic arch and proximal descending aorta present a unique surgical challenge due to their anatomical location, with neither standard sternotomy nor thoracotomy alone providing adequate exposure to complete a full repair. Conventional and frozen elephant trunk procedures have inherent problems, including high cumulative mortality and high spinal cord ischaemia rates, which may be obviated using a single-stage technique via bilateral thoracotomies or extended median sternotomy with left anterior thoracotomy.