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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm

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[One stage repair for extensive aortic aneurysm using the pull-through technique].

Keiji Iwata¹, Y Shimazaki, T Sakamoto

¹Department of Cardiovascular Surgery, Kinan Hospital, Tanabe, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery

|May 12, 2009

Summary

This study presents two complex aortic aneurysm cases in elderly women. A one-stage aortic arch and descending thoracic aorta replacement using the pull-through technique with a long elephant trunk (LET) proved successful, avoiding complications.

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Area of Science:

Cardiovascular Surgery
Vascular Surgery
Thoracic Surgery

Background:

Aortic aneurysms, particularly extensive ones involving the aortic arch and descending aorta, pose significant surgical challenges.
Management of complex aortic pathologies requires advanced techniques to ensure patient safety and optimal outcomes.

Observation:

Two cases of extensive aortic aneurysms are presented: a ruptured distal descending and arch aneurysm in an 88-year-old female, and an enlarging false lumen aneurysm in a 68-year-old female with prior acute type A dissection repair.
The 68-year-old patient had a history of graft replacement of the ascending aorta for acute type A dissection five years prior.

Findings:

A one-stage replacement of the aortic arch and descending thoracic aorta was performed using the pull-through technique with a long elephant trunk (LET).
The procedure was conducted via median sternotomy under selective cerebral perfusion, with the distal anastomosis of the LET performed through a posterior mediastinal approach.
Both patients experienced uneventful postoperative courses, with no neurological deterioration or respiratory distress.

Implications:

The described one-stage surgical approach using the pull-through technique with LET is a viable and effective strategy for managing extensive aortic arch and descending thoracic aorta aneurysms.
This technique, combined with selective cerebral perfusion, offers a safe and successful option for complex aortic reconstructions, even in high-risk patients.
The findings suggest that this method can lead to favorable outcomes, minimizing the risk of neurological and respiratory complications in patients with extensive aortic disease.