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Eur J Cardiothorac Surg 2002;21:597-598
© 2002 Elsevier Science NL
Letter to the Editor |
Department of Cardio-pulmonary Surgery, Graduate school of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
Received 16 November 2001; accepted 17 December 2001.
* Corresponding author. Department of Cardio-Thoracic Surgery, Graduate school of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Tel.: +81-3-5803-5270; fax: +81-3-5803-0141
e-mail: n-tabu.tsrg{at}tmd.ac.jp
Key Words: Stent-graft • Aortic dissection • Endoscope
We read the article by Orihashi et al. entitled ‘Endovascular stent-grafting via the aortic arch for distal aortic arch aneurysm’ with great interest [1]. In this report, the authors detail the surgical technique of arch replacement using stent-graft via the aortic arch. We would like to add two important points to the discussion in this article. This technique is highly useful, especially in the replacement of the aortic arch in acute dissection [2]. Stent-graft efficiently reinforces the dissected distal aorta to prevent the formation of new intimal tears in the anastomosis, which can result in a patent psuedo-lumen or bleeding [2]. For the implantation of a stent-graft on a dissected aorta, however, endoscopy is very helpful [2]. Although transesophageal echocardiography can provide important information about the zone blinded from the operation field [1,3], the dissected intima is extremely fragile and can still be injured or torn during the introduction of the delivery sheath bringing the stent-graft into the descending aorta. The endoscope, allowing accurate imaging of the distal aorta, safely controls movement of the delivery sheath by direct visualization [2]. Echocardiography is not capable of producing three-dimensional images, requiring additional image interpretation. Moreover, skilled echocardiography operators may not be available in the emergency situations. Visualization of the aortic intima, guiding insertion of the sheath, and final assessment of the surgical procedure outcome can easily be achieved using endoscopy. We have performed this technique during arch replacement in six patients with acute dissection; the operations were all successful. We believe that the combination of endoscopy and transesophageal echocardiography provides the best method to guide implantation of a stent-graft via the aortic arch.
References
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