scholarly journals Técnica del debranching híbrido tipo I del arco aórtico sin circulación extracorpórea

2019 ◽  
Vol 111 (4) ◽  
pp. 274-283
Author(s):  
Michel David ◽  
◽  
Raúl A. Borracci ◽  
Luis M. Ferreira ◽  
Patricio Giménez Ruiz ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Surgical Technique ◽  
Aortic Arch ◽  
Left Subclavian Artery ◽  
Ascending Aorta ◽  
Type I ◽  
Brachiocephalic Artery ◽  
Left Carotid Artery ◽  
Hybrid Treatment ◽  
Surgical Bypass

Aortic arch aneurysms represent a major challenge as the involvement of the supra-aortic vessels demands a complex surgical technique. Since the advent of endovascular aortic repair, hybrid treatment of aortic arch disease has emerged in recent years. The procedure consists of surgical bypass of the supra-aortic vessels followed by exclusion of the aneurysm with an endograft. This hybrid method is known as debranching and, briefly, consists in performing bypasses between the ascending aorta and the brachiocephalic artery, the left carotid artery and possibly the left subclavian artery without cardiopulmonary bypass, in order to advance an endograft to cover the entire lumen of the aneurysm. The aim of this paper is to describe the surgical technique of type I hybrid debranching without cardiopulmonary bypass and antegrade endograft delivery to treat aortic arch aneurysms.

Aneurysm Hybrid Treatment by Simultaneous Replacement of Ascending Aorta and Aortic Arch and Endoluminal Stenting of the Descending Aorta

2006 ◽  
Vol 9 (1) ◽  
pp. E530-E532
Author(s):  
Friedrich-Christian Riess ◽  
Hans Krankenberg ◽  
Thilo Tübler ◽  
Matthias Danne
Keyword(s):  
Aortic Arch ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
Hybrid Treatment

scholarly journals Ascending aorta and aortic root replacement in an infant: a case report

2021 ◽  
Vol 25 (3) ◽  
pp. 83
Author(s):  
V. A. Mironenko ◽  
V. S. Rasumovsky ◽  
A. A. Svobodov ◽  
S. V. Rychin
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Aortic Root ◽  
Common Carotid Artery ◽  
Left Subclavian Artery ◽  
Vascular Prosthesis ◽  
Ascending Aorta ◽  
Left Common Carotid Artery ◽  
Brachiocephalic Trunk

<p>We herein report the first clinical case of prosthetic replacement of the ascending aorta and aortic arch to repair a giant aneurysm in a 7-month-old child. The ascending aorta and arch replacement to the level of left subclavian artery was performed using a no. 16 Polymaille prosthesis, the brachiocephalic trunk was reimplanted into the vascular prosthesis and the kinked section of the left common carotid artery was removed, followed by reimplanting the left common carotid artery into the left subclavian artery. First, proximal anastomosis with the vascular prosthesis was created using a no. 16 Polymaille prosthesis and the vascular suture was strengthened with a Teflon strip. During circulatory arrest, the aortic arch was crossed between the orifice of the left common carotid artery and left subclavian artery, with the cut extended to the isthmus region along the small curvature of the arch. The brachiocephalic trunk was aligned and brought down, with subsequent implantation into the ascending aorta prosthesis 2 cm below the initial fixation point. In the final stage, the kinked section of the left common carotid artery was resected and the aligned left carotid artery was directly reimplanted into the left subclavian artery using end-to-side anastomosis. The patient developed tracheobronchitis and moderate heart failure during the postoperative period. The duration of mechanical ventilation was 16 hours. Infusion and antibacterial therapy were discontinued on postoperative day 8. On postoperative day 13, the patient was discharged and referred to the outpatient centre for further treatment and rehabilitation. A sufficiently large-sized prosthesis allows for further development in paediatric patients. This is facilitated by the preservation of the native aortic root with restored valve function and the formation of a bevelled distal anastomosis with a small unchanged aortic section in the isthmus region, which maintains growth potential. This first reported case of an infant demonstrates the possibility of combination interventions on the aortic arch and brachiocephalic artery during the first year of life.</p><p>Received 30 January 2021. Revised 24 March 2021. Accepted 29 March 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors: </strong>The authors contributed equally to this article.</p>

Anatomical Suitability of the Aortic Arch Arteries for a 3-Inner-Branch Arch Endograft

2020 ◽  
pp. 152660282095363
Author(s):  
Konstantinos Spanos ◽  
Stephan Haulon ◽  
Ahmed Eleshra ◽  
Fiona Rohlffs ◽  
Nikolaos Tsilimparis ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Left Subclavian Artery ◽  
Innominate Artery ◽  
Exclusion Criterion ◽  
Type I ◽  
Sinotubular Junction ◽  
Landing Zone ◽  
Custom Made ◽  
The Mean ◽  
Aortic Arch Arteries

Purpose: To analyze aortic arch anatomy of patients who were already treated with a 2-inner-branch arch endograft (2-IBAE) in order to assess the anatomical suitability of the supra-aortic arteries as target vessels for a 3-IBAE. Materials and Methods: Three different configurations of the Cook Zenith Arch endograft were designed with distances of 110 mm (model 1), 90 mm (model 2), and 70 mm (model 3) between the orifices of the first and third inner branches. Preoperative measurements of the aortic arch anatomy from 104 consecutive patients treated electively with custom-made 2-IBAEs at 2 European centers between 2014 and 2019 were analyzed. A previously described standard methodology with a planning sheet was used. Data and measurements included the treatment indication for the aortic arch pathology, the type of landing zone, the type of arch, and the inner and outer lengths of the ascending aorta from the sinotubular junction to the innominate artery (IA). Additionally, the diameters and clock positions of the IA, left common carotid artery (LCCA), and left subclavian artery (LSA) were assessed, along with the distances between the IA and the LCCA, the IA and the LSA, and the distal landing zone. Results: Type I was the most common arch configuration (75/104, 72%). The mean clock positions were 12:30±00:28 for the IA, 12:00±00:23 for the LCCA, and 12:15±00:29 for the LSA. The mean diameters were 14.2±2.2 mm for the IA, 8.8±1.8 mm for the LCCA, and 10.5±2 mm for the LSA. The mean distances between the IA and LCCA and between the IA and LSA were 14.7±5.8 mm and 33±9.4 mm, respectively. Model 2 (branch distance 90 mm) had the highest suitability (79%), while models 1 and 3 showed suitability rates of 73% and 68%, respectively. The most frequent exclusion criterion in all models was the diameter of the LSA, followed by the IA to LSA distance. Conclusion: The suitability for a 3-IBAE among patients who had a 2-IBAE implanted is high, favoring a 90-mm distance between the retrograde LSA branch and baseline.

scholarly journals Morphometry of the aortic arch and its branches

2013 ◽  
Vol 19 (3) ◽  
pp. 154-159 ◽  
Author(s):  
A.M. Manole ◽  
D.M. Iliescu ◽  
A. Rusali ◽  
P. Bordei
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Left Subclavian Artery ◽  
Ascending Aorta ◽  
Ct Scanner ◽  
Arterial Trunk ◽  
Brachiocephalic Trunk ◽  
The Right

Abstract Our study was conducted by the evaluation of angioCT’s performed on a GE LightSpeed VCT64 Slice CT Scanner. The measurements were performed on the aortic arch at the following levels: at the origin of the aorta, the middle part of the ascending aorta, prior to the origin of the brachiocephalic arterial trunk and after the origin of the left subclavian artery. We measured the caliber of the aortic arch arteries and the data are correlated and reported by gender. The diameter of the ascending aorta was between 27 to 28.9 mm in females and in males from 25.8 to 37.6 mm. The diameter of the aorta within the middle segment of the ascending part was between 28-30.2 mm in females and in males from 26.1 to 34.6. The diameter of the aortic arch prior to the origin of the brachiocephalic arterial trunk was between 26.4 to 29.4 mm in females and in males from 25.8 to 37.5 mm. The diameter of the aortic arch after the origin of the left subclavian artery was in a range of 20.4 to 28.4 mm, which corresponds to the limits found in males while in females the aortic diameter was between 21.3 to 24.1 mm. The brachiocephalic trunk diameters were 8.3 to 15.5 mm in females and in males was 9.1 to 14.5 mm. The right common carotid artery had a diameter of 4-8 mm diameter in males and in females ranged from 4.7 to 5.5 mm. The right subclavian artery showed a caliber of 5.7 to 7.5 mm in females and in males from 5.9 to 10.1. The left common carotid artery diameter was 4.6 to 5.7 mm in females and males the diameter was between 5.2 to 7.4 mm. The left subclavian artery had a diameter of 6-10 mm in females and in males ranged from 7.7 to 12.8 mm. We found that the distance between the ascending part of the aorta and the descending segment ranged from 33.3 to 38.5 mm in females and in males from 40 to 68.6 mm. We measured the distance that exists at the crossing of the aortic arch with the left branch of the pulmonary trunk, finding that in females this distance is 3 to 10.3 mm and in males from 3 to 12.5 mm.

scholarly journals Collateral Arteries of the Aortic Arch in Mongolian Gerbil (Meriones unguiculatus)

2018 ◽  
Vol 46 (1) ◽  
pp. 8
Author(s):  
Radan Elvis Matias de Oliveira ◽  
Hélio Norberto De Araújo Júnior ◽  
Herson Da Silva Costa ◽  
Gleidson Benevides De Oliveira ◽  
Carlos Eduardo Bezerra De Moura ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Subclavian Artery ◽  
Carotid Arteries ◽  
Left Subclavian Artery ◽  
Meriones Unguiculatus ◽  
Brachiocephalic Artery ◽  
Collateral Arteries ◽  
Brachiocephalic Trunk ◽  
The Right ◽  
Common Carotid Arteries

Background: Gerbils (Meriones unguiculatus) are rodents belonging to the Muridae family. Recently, breeding of this species as pets has increased significantly. Animal models are being investigated to study diseases related to the human aortic arch. Despite the importance of the aortic arch in maintaining homeostasis, there is limited data available regarding its morphology in gerbils. This study was performed with the objective of describing the collateral branches of the aortic arch in this animal to establish a standard model and thus contribute to future research on cardiovascular diseases in humans.Materials, Methods & Results: This study used 20 male specimens from previous studies that were frozen and stored at the Laboratory of Veterinary Anatomy of the Federal Rural University of the Semi-Arid Region. After thawing the animals, the thoracic cavity was opened for aortic cannulation. The vascular system was washed using saline solution and Neoprene latex stained with red pigment was injected. Subsequently, the animals were fixed in 10% formaldehyde and were dissected and analyzed 72 h later. The arrangement of the collateral branches of the aortic arch in gerbils was analyzed in all animals. The brachiocephalic trunk, the left common carotid, and the left subclavian artery were observed to originate as collateral branches. The brachiocephalic trunk bifurcated into the right common carotid and the right subclavian arteries. The right and the left subclavian arteries branched into the vertebral artery, the internal thoracic artery, the superficial cervical artery, the costocervical trunk, and the axillary artery.Discussion: Several studies reported in the literature describe the collateral branches of the aortic arch in domestic and wild mammalian species. These studies examined the main arteries that originate directly from the aortic arch and their respective branches, and classified the different anatomical variants of the aortic arch in each species. Three different arrangements have been commonly described. The first type corresponds only to the brachiocephalic artery originating from the aortic arch. The right and the left common carotid arteries and the right and the left subclavian arteries originate from this brachiocephalic artery. This type has already been described in the laboratory rat, catingueiro-deer, cattle, and horses. The second type is characterized by the presence of 2 arteries - the brachiocephalic trunk and the left subclavian artery. The right and the left common carotid arteries and the right subclavian artery originate from the brachiocephalic trunk. This arrangement has been reported in most species already studied such as rodents including the paca, chinchilla, guinea pig, mocó, nutria and the preá. The third type of vascular arrangement is observed in the gerbil. In this species, 3 collateral arteries originate from the aortic arch (the brachiocephalic trunk, the left common carotid, and the left subclavian artery). The right common carotid and the right subclavian artery originate from the brachiocephalic trunk. This vascular model has been described in the manatee, in humans, mice, sauim, and the monkey-nail. Thus, we concluded that the branching pattern of the aortic arch of the gerbil was characterized by the brachiocephalic trunk, the left common carotid, and the left subclavian artery, as has been described in mice, the manatee, monkey-nail, sauim, and humans. Based on these morphological characteristics, gerbils could serve as potential experimental models to study diseases related to the human aortic arch.

Reverse Subclavian Flap Repair and Maintenance of Antegrade Blood Flow within the Left Subclavian Artery in Neonates with Aortic Coarctation and Distal Arch Hypoplasia

2013 ◽  
Vol 16 (1) ◽  
pp. 52 ◽  
Author(s):  
Yuri S. Sinelnikov ◽  
A. V. Gorbatyh ◽  
S. M. Ivantsov ◽  
M. S. Strelnikova ◽  
I. A. Kornilov ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Aortic Coarctation ◽  
Left Subclavian Artery ◽  
Surgical Palliation ◽  
Flap Repair ◽  
Neonates And Infants ◽  
Aortic Arch Hypoplasia

Surgical palliation for aortic coarctation with aortic arch hypoplasia in neonates and infants has been used in the clinic as the most beneficial treatment for this disorder. This technique allows the correction of aortic coarctation by the use of "extended" anastomosis without cardiopulmonary bypass, which expands the hypoplastic distal aortic arch via the use of a reverse subclavian flap repair. This technique maintains antegrade blood flow within the left subclavian artery.

scholarly journals Replacement of ascending aorta and aortic arch combined with implantation of bare stent Djumbodis® Dissection System as a treatment of type I aortic dissection

2016 ◽  
Vol 20 (4) ◽  
pp. 66 ◽  
Author(s):  
R. N. Komarov ◽  
Yu. V. Belov ◽  
P. A. Karavaykin ◽  
M. A. Soborov
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Conflict Of Interest ◽  
Prolonged Mechanical Ventilation ◽  
Circulatory Arrest ◽  
False Lumen ◽  
Operation Time ◽  
Ascending Aorta ◽  
Type I ◽  
Cardiovascular Failure

<p><strong>Aim.</strong> The aim of this study is to show the outcomes of an open intervention on the ascending aorta and arch combined with stenting of aorta in type I aortic dissection.<br /><strong>Methods.</strong> 6 patients with type I aortic dissection underwent implantation of Djumbodis® Dissection System bare stents at I.M. Sechenov First Moscow Medical University’s Aortic and Cardiovascular Surgery Clinic. In 4 patients, aortic stenting was combined with ascending aorta replacement, in 1 patient, hemiarch ascending aorta and arch replacement was performed and in 1 patient aorta and arch replacement was complemented with a Sun procedure.<br /><strong>Results.</strong> Total operation time, cardiopulmonary bypass time, cross clamp time and hypothermic circulatory arrest time were just similar to those performed in conventional open surgery. There were no intraoperative deaths in this series. 30-day mortality was 16.7 % (1 patient). The patient died because of progressive respiratory and cardiovascular failure, encephalopathy, and gastrointestinal bleeding. 1 patient had acute renal failure and left leg ischemia because of the false lumen thrombosis, 1 patient suffered from cardiac tamponade and 1 patient underwent prolonged mechanical ventilation. Total false lumen thrombosis developed in 1 patient, 4 patients had partial false lumen thrombosis, and in 1 patient the false lumen remained patent.<br /><strong>Conclusion.</strong> Stenting of aortic arch and descending aorta is a good alternative to aortic arch replacement in type I aortic dissection. It promotes stabilization of false and true lumen diameters and global aortic diameter.</p><p>Received 18 October 2016. Accepted 7 November 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Komarov R.N., Soborov M.A.<br />Material acquisition and analysis: Karavaykin P.A. <br />Project curation: Komarov R.N., Belov Yu.V.<br />Article writing: Karavaykin P.A. <br />Review &amp; editing: Komarov R.N., Belov Yu.V., Soborov M.A.</p>

Sign in / Sign up

Export Citation Format

Share Document