Abstract

Aims: We evaluated the application of a new combined surgical and endovascular technique for the treatment of the aortic arch. The technique is used to treat extensive aortic disease by a single-stage procedure. Surgical outcomes and follow-up data are summarized and analyzed. Methods: Between August 2005 and July 2007, ten patients (54±11,7 years; 8 male, 2 female) with aortic pathologies (7 dissections, 3 aneurysms) underwent replacement of the ascending aorta and the aortic arch, and simultaneous stent graft implantation into the descending aorta. The stent graft was implanted using the E-vita open endoluminal stent graft, employing the technique of circulatory arrest and moderate hypothermia with selective antegrade cerebral perfusion. The stent graft was deployed under visual guidance through the open aortic arch into the true lumen. Results: Intraoperative antegrade stenting of the descending aorta combined with the distal ascending aorta and aortic arch repair was performed successfully in all patients; a survival rate of 100% was achieved. Two patients had a postoperative neurological deficit but recovered almost completely. Seven patients had fully thrombosed perigraft spaces within 11 days, while two patients showed complete obliteration of the false lumen at the three-month control. Conclusion: The combined surgical and endovascular technique described in this report proved feasible for the treatment of extended aortic lesions. It serves as an additional option for aortic repair in a single-stage method and is associated with no elevated risk for the patient.

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