Thorac Cardiovasc Surg 2021; 69(04): 362-365
DOI: 10.1055/s-0040-1715434
How to Do It

Suturing Fenestration of the Left Subclavian Artery Orifice in Frozen Elephant Trunk Procedure

Mitsumasa Hata
1   Department of Cardiovascular Surgery, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
,
Shinji Wakui
1   Department of Cardiovascular Surgery, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
,
Yusuke Ishii
1   Department of Cardiovascular Surgery, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
,
Rei Hinoura
1   Department of Cardiovascular Surgery, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
,
Susumu Isaka
1   Department of Cardiovascular Surgery, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
,
Masashi Tanaka
2   Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
› Author Affiliations

Abstract

The frozen elephant trunk (FET) procedure enables easier replacement of the entire aortic arch because it does not require reaching the distal part of the left subclavian artery (LSCA). However, it requires additional management for reconstruction of the LSCA, which is associated with bleeding events. However, the fenestrated FET technique confers a risk of endoleakage from the fenestration site. We report our unique novel technique in which the proximal side of the hybrid stent graft is cut into V-shape around the subclavian artery and sutured continuously around the orifice of the subclavian artery during aortic stump fixation.



Publication History

Received: 14 February 2020

Accepted: 10 June 2020

Article published online:
08 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Okamura H, Arakawa M, Takeuchi T, Adachi H. The fenestrated frozen elephant trunk technique for acute type A aortic dissection. J Thorac Cardiovasc Surg 2018; 156 (02) e75-e77
  • 2 Hata M, Orime Y, Wakui S. et al. Efficacy of a newly modified technique for distal limited open stenting in octogenarians with aortic arch aneurysm. J Thorac Cardiovasc Surg 2017; 153 (03) 530-535
  • 3 Buth J, Harris PL, Hobo R. et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg 2007; 46 (06) 1103-1110 , discussion 1110–1111
  • 4 Tsagakis K, Dohle DS, Wendt D. et al. Left subclavian artery rerouting and selective perfusion management in frozen elephant trunk surgery. Minim Invasive Ther Allied Technol 2015; 24 (05) 311-316
  • 5 Qi RD, Zhu JM, Liu YM. et al. Distal arch aneurysm repair using left subclavian artery transposition with stented elephant trunk in the hybrid repair era. Heart Lung Circ 2019; 28 (05) 814-819