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Combined Open Proximal and Stent-Graft Distal Repair for Distal Arch Aneurysms: An Alternative to Total Debranching

^a Division of Cardiothoracic Surgery, Center for Diseases of the Thoracic Aorta, Washington University School of Medicine, St. Louis, Missouri
^b Division of Vascular Surgery, Center for Diseases of the Thoracic Aorta, Washington University School of Medicine, St. Louis, Missouri

Accepted for publication October 8, 2008.

^_* Address correspondence to Dr Moon, Division of Cardiothoracic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Box 8234, St. Louis, Missouri 63110 (Email: moonm{at}wustl.edu).

Presented at the Video Session of the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.

We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta.