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Anterograde thoracic endovascular aortic repair with mini-thoracotomy
Yun ChiHyeong, Jr., Oh SangGi.
Chonnam National University Hospital, GwangJu, Korea, Republic of.

Object: Thoracic endovascular aortic repair (TEVAR) is an accepted alternative to conventional surgery in selected patients. However, TEVAR is impossible with severe iliac disease or a tortuous aorta. We report on anterograde TEVAR combined with video-assisted thoracic surgery (VATS).
Method: From January 2002 to May 2002, we performed anterograde TEVAR with VATS on 2 patients with a diseased aortic or iliac artery. the supra-aortic branch needed to be revascularized to create the landing zone for the stent-graft in 1 patient.
Result :There were no operative deaths. In 1 patient, the stent graft remains collapsed, but seals the aortic aneurysm completely
Conclusion: The anterograde TEVAR may be effective for thoracic aortic aneurysm with a diseased aortic or iliac artery. but further investigation is necessary.
Fig. 1. Mini-thoracotomy exposure of the ascending aorta after division of the thymus (A, B). The thoracic aortogram shows multiple ulcerated pits (arrow) at the aortic arch and descending thoracic aorta (C, E). After deployment of an 18-Fr delivery sheath at the ascending aorta (*), the endovascular prosthesis passed from the ascending aorta to the descending thoracic aorta. Angiograms show complete sealing of the ulcerated pits in the aortic arch and descending thoracic aorta (D, F).

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