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Paolo Vanelli
Guido Gelpi
Massimo Lemma
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Ann Thorac Surg 2007;83:1158-1161
© 2007 The Society of Thoracic Surgeons

New Technology

Hybrid Technique for Total Arch Repair: Aortic Neck Reshaping for Endovascular-Graft Fixation

Carlo Antona, MDa, Paolo Vanelli, MDa,*, Marina Petullà, MDb, Guido Gelpi, MDa, Paolo Danna, MDa, Massimo Lemma, MDa, Luigi Inglese, MDc

a Department of Cardiovascular Surgery, Azienda Ospedaliera Polo Universitario "Luigi Sacco," Milan, Italy
b Department of Radiology, Azienda Ospedaliera Polo Universitario "Luigi Sacco," Milan, Italy
c Laboratorio di Emodinamica e Radiologia Cardiovascolare Istituto Policlinico San Donato, San Donato Milanese, Italy

Accepted for publication July 6, 2006.

* Address correspondence to Dr Vanelli, Department of Cardiovascular Surgery, Azienda Ospedaliera Polo Universitario "Luigi Sacco" Via G.B. Grassi, 74 20157 Milan, Italy (Email: p.vanelli{at}hsacco.it).

Purpose: Endovascular repairs of the aortic arch aneurysms require correct placement and an appropriate landing zone for fixation, which are not present in the majority of cases.

Description: We report a less invasive approach in 4 patients presenting an aortic arch aneurysm. We performed a hybrid procedure that is a combination of different techniques: a mid-sternotomy is performed, followed by transposition of the supra-aortic vessels, and neck reshaping with a proximal banding of the aortic arch. In particular, we banded the aorta to facilitate and optimize the endovascular fixation of the graft, reducing postoperative type-1 endoleaks.

Evaluation: The four procedures were uneventful with 1-day intensive care unit recovery. The postoperative and the 1-year follow-up CT scan did not reveal any endoleaks.

Conclusions: Hybrid technique, combined with banding of proximal aortic arch and endovascular grafting are an alternative technique to the conventional open aortic repair. A polyester cloth banding of the ascending and proximal aortic arch allow the neck reshaping of the aorta optimizing the fixation of the endovascular stent graft.




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