Two-stage hybrid surgical repair for aortic arch pathology with a shaggy aorta: a case report

Journal of Cardiothoracic Surgery, 2024 · DOI: https://doi.org/10.1186/s13019-024-02841-5 · Published: June 14, 2024

Simple Explanation

This case report describes a surgical approach for treating aortic arch aneurysms associated with a 'shaggy aorta,' a condition where the aorta has a high risk of causing stroke due to plaque buildup. The patient underwent a two-stage procedure: first, abdominal aortic aneurysm graft replacement, followed by total arch replacement (TAR) combined with thoracic endovascular aortic repair (TEVAR). The strategy aimed to minimize the risk of stroke by using techniques such as functional brain isolation during surgery, ensuring blood flow to the brain is maintained while manipulating the aorta.

Study Duration

Not specified

Participants

63-year-old man

Evidence Level

Level 4: Case Report

Key Findings

1
Total arch replacement with the conventional elephant trunk and secondary thoracic endovascular aortic repair may be an effective alternative for aortic arch pathology with a shaggy aorta.
2
The functional brain isolation technique, involving retrograde perfusion to the brain from neck vessels and unclamping of the orifices of neck vessels, was adopted as an effective alternative.
3
Adding the left CCA to the bilateral AxAs as the arterial inflow for CPB could result in functional total occlusion in the native left CCA.

Research Summary

The surgical treatment strategy for aortic arch pathology with a shaggy aorta must be determined on a case-by-case basis because of the risk of catastrophic complications, such as brain infarction and spinal cord injury. This report describes the surgical case of two saccular aneurysms of the arch and abdominal aorta associated with a shaggy aorta in a 63-year-old man who underwent total arch replacement and secondary thoracic endovascular aortic repair. The present case suggests that total arch replacement with the conventional elephant trunk and secondary thoracic endovascular aortic repair may be an effective alternative for aortic arch pathology with a shaggy aorta.

Practical Implications

Surgical Strategy

The strategy for surgical treatment in patients with aortic arch pathologies with a shaggy aorta must be judged on a case-by-case basis.

Brain Protection

TAR-reinforcing brain protection is considered an effective treatment of choice for aortic arch pathologies associated with severe atheroma.

Stent Graft Implantation

Secondary conventional stent graft implantation supports precise deployment of the stent graft to its intended position, completely excluding the diseased aortic segment, under prudent TEE and fluoroscopic guidance.

Study Limitations

1
The strategy for surgical treatment in patients with aortic arch pathologies and a shaggy aorta must be judged on a case-by-case basis.
2
It was unclear whether adequate cerebral perfusion was ensured with the functional brain isolation technique.
3
The lack of adjunctive techniques to prevent embolization to the abdominal viscera and lower extremities, and cerebrospi-nal fluid drainage to reduce spinal cord injury.

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