Related Experiment Video
Updated: Aug 22, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Open aortic surgical repair for left hemi-arch stent-graft failure
Vincenzo Rampoldi1, Santi Trimarchi, Paolo Righini
1Department of Vascular Surgery, Istituto Policlinico San Donato, San Donato Milanese, Italy.
Insights
This study presents a safe surgical technique for removing failed aortic stent grafts. The open aortic approach with cerebral perfusion effectively treated complex aortic diseases with no mortality.
Area of Science:
- Cardiovascular Surgery
- Endovascular Surgery
- Thoracic Surgery
Background:
- Endovascular stent grafts are used for aortic diseases.
- Type I endoleaks can cause aortic enlargement after stent graft placement.
- Complications necessitate alternative treatment strategies.
Observation:
- Three patients with stent graft failure due to type I endoleaks underwent open aortic explant.
- The failure was characterized by rapid aortic diameter enlargement.
- Proximal stent placement precluded simple aortic cross-clamping.
Findings:
- An open aortic approach via left posterolateral thoracotomy was performed.
- Techniques included femoro-femoral bypass, hypothermic circulatory arrest, and selective antegrade cerebral perfusion.
- Graft explant and aortic replacement were successful with no surgical mortality or major complications.
Implications:
- This surgical technique is a safe and effective option for treating complex aortic pathologies involving stent graft failure.
- Rapid stent graft explant and selective cerebral perfusion are key components of this strategy.
- The approach addresses a new challenge in aortic disease management.
Abstract:
A surgical technique of endovascular graft explant through an open aortic approach for left hemi-arch stent-graft failure is described. Between January and April 2003, we surgically treated 3 patients previously submitted for stent grafts for isthmic aortic diseases. Two patients had atherosclerotic aneurysm and 1 had a false lumen reperfusion of subacute intramural hematoma. At 6 to 8 months computed tomographic scan follow-ups on all patients showed a rapid enlargement of aortic diameters due to type I endoleaks. The presence of an uncovered proximal stent in the parasubclavian aorta did not allow a simple aortic cross clamping; therefore we performed an open aortic procedure through a left posterolateral thoracotomy, using femoro-femoral bypass and mild hypothermic circulatory arrest. Selective antegrade cerebral perfusion was started within 3 to 5 minutes from aortotomy and graft removal. Left hemi-arch and descending thoracic aortic replacement was then performed with continuous cerebral perfusion. No surgical mortality was observed. Postoperative course was uneventful for neurologic, cardiac, respiratory, and renal complications. The 3-month follow-ups were event free. This approach, associated with rapid stent-graft explant and selective cerebral antegrade perfusion, appears to be a safe and effective surgical strategy for treating this new aortic pathology.
