References
Szeto WY, Bavaria JE, Bowen FW, Woo EY, Fairman RM, Pochettino A. The
hybrid total arch repair: brachiocephalic bypass and concomitant
endovascular aortic arch stent graft placement. J Card Surg .
2007;22(2):97-104.
Ghazy T, Mashhour A, Schmidt T, et al. Off-Pump Debranching and
Thoracic Endovascular Aortic Repair for Aortic Arch Pathology.
Innovations (Phila). 2015;10(3):163-169.
Figure 1. Preoperative 3D reconstruction obtained from computed
tomography angiogram of the chest showing a pseudoaneurysm located at
the inferior-posterior wall of the aortic isthmus, in anterior (A) and
posterior (B) views.
Figure 2. Schematic illustration and intraoperative pictures
(anesthetist view). A and B, Exposure of the ascending aorta and head
vessels; C, A plaque-free portion of the ascending aorta is clamped
tangentially using a partial side-biting clamp, followed by longitudinal
arteriotomy; D, Completed end-to-side anastomosis of the main graft limb
to the ascending aorta; E, Anastomosis of the middle graft limb to the
distal end of the left common carotid artery. Each proximal arterial
stump is ligated to prevent a type II endoleak (white arrow); F, Final
result of the procedure. Metal clips were circumferentially placed 2 cm
above the proximal aorta-to-graft anastomotic line to allow
determination of the endoprosthesis landing zone in the second stage of
the procedure (white arrows). 1, ascending aorta; 2, left
brachiocephalic vein; 3, left common carotid artery; 4, innominate
artery; 5, limb graft elongating the left subclavian artery distally.
Figure 3. Final result of the two-stage procedure in 3D
reconstruction obtained from a computed tomography angiogram of the
chest showing the supra-aortic vessels being rerouted to the ascending
aorta and the proper position of the aortic stent with proximal landing
in zone 0, excluding the pseudoaneurysm from the aortic lumen, in left
anterior (A) and right posterior (B) views.