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Ann Thorac Surg 2004;78:1075-1078
© 2004 The Society of Thoracic Surgeons

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Case report

Open aortic surgical repair for left hemi-arch stent-graft failure

^a Department of Vascular Surgery, San Donato Milanese, Italy
^b Cardiac Catheterization Laboratory, Istituto Policlinico San Donato, San Donato Milanese, Italy

Accepted for publication March 15, 2004.

^* Address reprint requests to Dr Trimarchi, Istituto Policlinico San Donato, via Morandi 30, San Donato Milanese 20097, Italy
satrimarchi{at}yahoo.it

A surgical technique of endovascular graft explant through an open aortic approach for left hemi-arch stent-graft failure is described. Between January and April 2003, we surgically treated 3 patients previously submitted for stent grafts for isthmic aortic diseases. Two patients had atherosclerotic aneurysm and 1 had a false lumen reperfusion of subacute intramural hematoma. At 6 to 8 months computed tomographic scan follow-ups on all patients showed a rapid enlargement of aortic diameters due to type I endoleaks. The presence of an uncovered proximal stent in the parasubclavian aorta did not allow a simple aortic cross clamping; therefore we performed an open aortic procedure through a left posterolateral thoracotomy, using femoro-femoral bypass and mild hypothermic circulatory arrest. Selective antegrade cerebral perfusion was started within 3 to 5 minutes from aortotomy and graft removal. Left hemi-arch and descending thoracic aortic replacement was then performed with continuous cerebral perfusion. No surgical mortality was observed. Postoperative course was uneventful for neurologic, cardiac, respiratory, and renal complications. The 3-month follow-ups were event free. This approach, associated with rapid stent-graft explant and selective cerebral antegrade perfusion, appears to be a safe and effective surgical strategy for treating this new aortic pathology.

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