International Society For Minimally Invasive Cardiothoracic Surgery

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Pitfall For Debranching With Endovascular Aneurysm Repair
FUMIKAZU NOMURA, Masato Suzuki, Syunsuke Ohori, Kiyotaka Morimoto, Kisyu Fujita, Yohei Ohkawa, Takemi Ohno.
HOKKAIDO OHNO MEMORIAL HOSPITAL, SAPPORO, Japan.

Background: Strategies of debranching three cerebral vessels and visceral arteries subsequent endovascular aneurysm exclusion are considered to be reasonable and relatively safe procedure for complex thoracic and thoracoabdominal aortic aneurysm. This study demonstrates the pitfall of these procedures especially focusing on the aortic stiffness.Metods: We have done 47 debranch TEVAR including one or two cerebral arteries debranch. 9 of 47 received total cerebral artery debranch subsequen endovascular repair. 10 of 47 received visceral debranch subsequent endovascular repair.Results: 1 out of 9 total cerebral debranch (11%) died of shower emboli at the time of TEVAR. 1 out of 10 visceral debranch died of brain hemorrhage (10%). 3 out of 28 one or two cerebral artery debranch died of interstitial pneumonia, aneurymal rupture, and brain hemorrhage (10.7%). About 10% mortality with one right hemiplegia (2% major morbidity) are satisfactory, however, 2 brain hemorrhage (4.2%) after endovascular repair lead to death is considered to be crucial pitfall for the foloow up of these patients with stiff aorta like lead pipe.
Conclusion: Visceral debranch including total arch replacement, multiple TEVAR showed almost entire aortic replacement with a fairly non-compliant and non-elastic long graft. This lack of elasticity is speculated much more excessive in endovascular graft than surgically implanted graft. The meticulous and aggressive blood pressure control should be mandatory after this hybrid repair.


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