Kansal V, Hadziomerovic A, Nagpal S
University of Ottawa, Faculty of Medicine, Canada.
University of Ottawa, Division of Interventional Radiology, Canada.
EJVES Short Rep. 2016 Aug 3;32:29-32. doi: 10.1016/j.ejvssr.2016.06.002. eCollection 2016.
Ascending aortic pathology presents a unique challenge for treatment by thoracic endovascular aortic repair (TEVAR), because of lack of adequate endograft landing zones. This report describes a unique "reverse" extra-anatomical aortic arch debranching procedure performed to enable TEVAR of the ascending aorta.
A 71-year-old male presented with a large ascending aortic pseudoaneurysm secondary to previous arch repair anastomosis. This pathology was treated by TEVAR of the ascending aorta. To create a sufficient landing zone for the endovascular stent graft, a "reverse" extra-anatomical aortic arch debranching procedure was performed. This involved a left subclavian artery to left carotid artery bypass, left to right carotid-to-carotid bypass, ligation of proximal left common carotid artery, and embolization of the innominate artery origin.
TEVAR of the ascending aorta can be made feasible through a novel debranching procedure that creates sufficient landing zones for the endograft. This surgical approach may prove useful in patients who present with aortic arch pathology and comorbidities that prevent open surgical repair.
升主动脉病变给胸主动脉腔内修复术（TEVAR）带来了独特的挑战，因为缺乏足够的腔内移植物着陆区。本报告描述了一种独特的“反向”解剖外主动脉弓去分支手术，以实现升主动脉的TEVAR。
一名71岁男性因先前的主动脉弓修复吻合术后出现巨大升主动脉假性动脉瘤。该病变通过升主动脉的TEVAR进行治疗。为了为血管内支架移植物创建足够的着陆区，进行了“反向”解剖外主动脉弓去分支手术。这包括左锁骨下动脉至左颈动脉旁路、左至右颈动脉旁路、近端左颈总动脉结扎以及无名动脉起始处的栓塞。
通过一种新颖的去分支手术为腔内移植物创建足够的着陆区，可以使升主动脉的TEVAR变得可行。这种手术方法可能对那些患有主动脉弓病变和合并症而无法进行开放手术修复的患者有用。
