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Eur J Cardiothorac Surg 2006;29:709-713
© 2006 Elsevier Science NL

Transposition of the supraaortic branches for extended endovascular arch repair

^a Department of Cardiothoracic Surgery, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria
^b Department of Interventional Radiology, University of Vienna Medical School, Vienna, Austria

Received 3 October 2005; received in revised form 30 November 2005; accepted 13 December 2005.

^_* Corresponding author. Tel.: +43 1 40 400 5643; fax: +43 1 40 400 5642. (Email: bypass{at}eunet.at).

Background: Supraaortic branches limit extended application of endovascular aortic repair. For this purpose, we applied extensive reconstructions. Methods: Between October 2002 and March 2005, 11 patients (mean age 72.3 years) presented with acute or chronic aortic diseases originating from the aortic arch (arch aneurysms n = 8, type B dissections n = 3). Treatment was by autologous sequential transposition of the left carotid artery into the brachiocephalic trunk and of the left subclavian artery into the already transposed left common carotid artery in nine patients and by additional reconstruction of the brachiocephalic trunk in two patients. Endovascular stent-graft placement was successfully performed thereafter. Results: Procedure-related mortality was 0%. At completion angiography, all reconstructions were fully patent. One patient had a small type Ia endoleak that resolved spontaneously within one week. Mean follow-up was 18 months (1–29 months). One patient underwent redo stent-graft placement after 25 months due to a type III endoleak. The remaining patients had normal follow-up CT scans with regular perfusion of the supraaortic branches without any signs of endoleaks. Conclusions: Extended application of this technique will enable safe and effective treatment of a highly selected group of patients by avoiding conventional repair.

Key Words: Aortic arch aneurysm • Supraaortic reconstruction • Endovascular stent-graft placement

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