Endovascular Hybrid Aortic Arch Repair
Despite substantial advances in refining conventional surgical technique, there still remain elderly or physiologically frail patients who should probably not undergo standard arch replacement. This may be true in particular for patients with multisegment
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Martin Czerny, Michael Grimm, and Martin Funovics
Contents 48.1
Background................................................... 527
48.2 48.2.1 48.2.2 48.2.3
Indications for Combined Approaches ...... Patient Selection............................................. Preoperative Evaluation ................................. Imaging ..........................................................
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48.3 48.3.1 48.3.2 48.3.3 48.3.4
Surgical Approach ....................................... Subclavian-to-Carotid Transposition ............. Double Transposition ..................................... Involvement of the Brachiocephalic Truck .... Stent-Graft System .........................................
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M. Czerny, M.D. () Department of Cardiovascular Surgery, University Hospital Berne, Freiburgstrasse, Berne 3010, Switzerland e-mail: [email protected] M. Grimm, M.D. Department of Cardiothoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria e-mail: [email protected] M. Funovics, M.D. Department of Interventional Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria e-mail: [email protected]
48.4 Summary of Outcomes ................................ 531 48.4.1 Arch Rerouting............................................... 531 48.4.2 Endoleak Formation and Treatment .............. 531 48.5
Comment....................................................... 532
References ................................................................. 534
48.1
Background
Despite substantial advances in refining conventional surgical technique, there still remain elderly or physiologically frail patients who should probably not undergo standard arch replacement. This may be true in particular for patients with multisegmental thoracic aortic disease originating at the level of the aortic arch. TEVAR has broadened treatment options in acute and chronic thoracic aortic disease and has proven durability [1–9]. As a prerequisite, the potential of the method, its limitations, as well as strict indications have to be known and followed. As such, a long landing zone, proximal and distal, has turned out to be a prerequisite for stable results [1]. If anatomy is unsuitable, suitability may be created by transposition of supraaortic branches [7–10]. By this clinical need, subclavian-to-carotid transposition regained popularity, and a new indication for this operation was present [11]. It was soon realized that there was clinical need for extending reroutings more proximal. As such, autologous double transposition entered the stage in 2002 and became the standard approach for distal arch disease [12]. However,
R.G.C. Inderbitzi et al. (eds.), Minimally Invasive Thoracic and Cardiac Surgery, DOI 10.1007/978-3-642-11861-6_48, © Springer-Verlag Berlin Heidelberg 2012
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some patients required an even more pr
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