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Right Anterior Minithoracotomy For Thoracic Endovascular Aortic Repair After Prosthetic Graft Replacement Of The Ascending Thoracic Aorta
Mohamed Hassan, Kiril Penov, Dejan Radakovic, Nodir Madrahimov, Ivan Aleksic, Khaled Hamouda;
University Hospital of Wuerzburg, würzburg, Germany
BACKGROUND: The common femoral artery is the standard access route for thoracic endovascular aortic repair (TEVAR). However, but is still a significant issue in a patient population that often has many comorbidities including peripheral arterial disease, so that other routes must be considered.
METHODS: Between December 2021 and Juni 2023, three patients underwent five TEVAR procedures. Among them, there were two male patients, mean age 62, who underwent antegrade stent-graft deployment using the ascending aortic prothetic graft as access route. Particularly, for degenerative aneurysms of the descending aorta, two patients for aneurysm of descending thoracic aorta and one patient for penetrating aortic ulcer.
Since one patient had severe chronic obstructive pulmonary disease and the other two patients were considered high risk patients after aortic surgery for type A aortic dissection, one-stage replacement of the thoracoabdominal aortic aneurysm was contraindicated and TEVAR on the descending aorta was selected. The peripheral artery disease with iliofemoral involvement hampered endovascular access to the site from the common femoral artery.We chose to access the ascendingl aorta prosthetic graft with a thoracotomy from the right third intercostal space for TEVAR.
RESULTS:The 30-day postoperative mortality was 0 %. No endoleaks were observed postoperatively and in median follow-up period of 26 weeks using contrast-enhanced computed tomography (CT). In the midterm and a mean follow-up of 6 months. there were no deaths related to the stent-graft implantation.
CONCLUSIONS:Our findings suggest that TEVAR can be performed by using the prosthetic ascending aortic graft through a right anterior thoracotomy as access route, if variations of vascular anatomy or peripheral artery disease interfere with the more commonly used femoral artery approach.
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