Total endograft replacement of aortic arch.

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Aortic Aneurysm Repair

Background:

• Aortic arch aneurysms often require complex surgical repair.
• Standard median sternotomy and hypothermic circulatory arrest carry significant risks.
• Endovascular techniques offer a less invasive alternative for aortic pathologies.

Purpose of the Study:

• To describe a technique for total endovascular aortic arch replacement.
• To present a case of successful endograft repair in a patient with large aortic arch and descending thoracoabdominal aneurysms.
• To highlight the advantages of this approach over conventional sternotomy.

Main Methods:

• The procedure involved bilateral carotid-subclavian bypasses followed by endograft deployment via a common iliac artery access.
• A long sheath and specialized wire were used for precise endograft placement into the left ventricle.
• Retrograde cannulation of arch branches with bridging stents was performed.
• The endograft delivery system was removed, completing the repair.

Main Results:

• Successful endovascular repair of a 6.5 cm aortic arch aneurysm and a 5.4 cm descending thoracoabdominal aneurysm.
• The procedure avoided the need for median sternotomy, extra-anatomic debranching, and hypothermic circulatory arrest.
• The patient underwent a less invasive repair with successful branch vessel revascularization.

Conclusions:

• Total endovascular aortic arch replacement is a feasible and effective alternative to open surgery for complex aneurysms.
• This technique offers a less invasive approach, potentially reducing morbidity and mortality.
• The described method provides a viable option when sternotomy is precluded by patient anatomy or comorbidities.