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Surgical repair of a distal arch aneurysm with a stent-graft
Kazuhiko Higuchi1, Kenzi Koseni, Motoyuki Hisaki
1Department of Cardiac Surgery, Asahi General Hospital, I-1236 Asahi, Chiba 289-2511, Japan. higux@blue.ocn.ne.jp
Insights
Stent-grafting for distal arch aneurysms shows promise with no early mortality. However, endovascular leakage remains a concern, necessitating prompt re-intervention if identified post-procedure.
Area of Science:
- Cardiovascular Surgery
- Vascular Endovascular Therapy
Background:
- Distal arch aneurysms pose significant surgical challenges.
- Traditional open repair carries substantial risks.
Purpose of the Study:
- To evaluate the efficacy and safety of stent-grafting for distal arch aneurysms.
- To assess complications associated with this endovascular technique.
Main Methods:
- Nine patients with distal arch aneurysms underwent stent-graft repair.
- Procedures utilized profound hypothermia and circulatory arrest with retrograde cerebral perfusion.
- Postoperative surveillance included 3D CT scans to detect endovascular leakage.
Main Results:
- Zero 30-day mortality.
- Mean follow-up of 27.4 months.
- One late death occurred due to proximal leakage; no cerebral infarction or paraplegia reported.
Conclusions:
- Stent-grafting is a potentially effective treatment for distal arch aneurysms.
- Endovascular leakage is a significant concern requiring vigilant monitoring and potential re-intervention.
- Longer follow-up is needed to fully ascertain the long-term outcomes.
Abstract:
This study evaluates the effectiveness and potential complications of stent-grafting for the treatment of distal arch aneurysms using profound hypothermia and circulatory arrest with retrograde cerebral perfusion. Between December 1998 and December 2001, 9 consecutive patients with a distal arch aneurysm (6 men and 3 women, mean age 71 years) underwent surgical repair using a stent-graft. Profound hypothermic circulatory arrest and retrograde cerebral perfusion were performed in all patients. Endovascular leakage was screened postoperatively using three-dimensional computerized tomography. The mean follow-up period was 27.4 months. Thirty day mortality was 0%. One patient died 3 months after stent-grafting due to proximal leakage into her aneurysm. The mean postoperative extubation period was 2.1 days. No patients suffered cerebral infarction or paraplegia. Although preliminary outcomes using this technique were good, endovascular leakage is a concern. We suggest that, if major proximal leakage is recognized postoperatively, re-intervention should be performed as soon as possible. Endovascular stent-grafting appears to be a good alternative treatment for distal arch aneurysms, although longer follow-up is necessary to more comprehensively evaluate this procedure.
