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Stent-Grafting of the Thoracic Aorta by the Cardiothoracic Surgeon

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Presentation on theme: "Stent-Grafting of the Thoracic Aorta by the Cardiothoracic Surgeon"— Presentation transcript:

1 Stent-Grafting of the Thoracic Aorta by the Cardiothoracic Surgeon
Burkhart Zipfel, MD, Robert Hammerschmidt, MD, Thomas Krabatsch, MD, PhD, Semih Buz, MD, Yuguo Weng, MD, PhD, Roland Hetzer, MD, PhD  The Annals of Thoracic Surgery  Volume 83, Issue 2, Pages (February 2007) DOI: /j.athoracsur Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Endovascular access. a) Routine angioaccess consists of exposure of the common femoral artery with a small oblique incision. The delivery system of the stent-graft is advanced directly over the puncture site without arteriotomy guided by the ultrastiff guidewire. b) For the access conduit, a 10-mm Dacron graft has been sutured end to side to the distal abdominal aorta (Fig 3). A 24F sheath is passed through this graft into the suprarenal aorta. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Hybrid procedure for a thoracoabdominal aneurysm in a 72-year-old woman. The celiac axis ostium was covered by the stent-graft (E-vita). The 10-mm Dacron access graft to the distal abdominal aorta was used as a bypass for iliac artery reconstruction after deployment of the endograft. A second bypass (6-mm expanded polytetrafluoroethylene) to the common hepatic artery was anastomosed on top. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Endograft (E-vita in two long segments) of the entire descending thoracic aorta from the left common carotid artery down to the celiac trunk. The left subclavian artery has been transposed to the left common carotid artery preliminarily and is not excluded by the stent-graft. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Intraoperative angiograms of a 19-year-old patient with blunt traumatic rupture. (Left) False aneurysm close to the left subclavian artery origin. The endograft delivery catheter is already in park position downstream. (Right) A Talent stent-graft is in place: the Dacron starts immediately downstream of the left common carotid artery; the bare springs are crossing it. The left subclavian artery is occluded. The stent-graft is oversized by 27% and expands to its full diameter at the spot of the rupture. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Distribution of proximal endograft attachments (full diameter graft material; bare springs may reach further in proximal direction). Modified from Criado et al [6]: zone C, inside a previously placed conventional surgical graft; zone E, inside a previously placed endograft. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 Actuarial survival for all patients.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 7 Development of endovascular stent-grafting at the Deutsches Herzzentrum Berlin. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

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