Hybrid technique for total arch repair: aortic neck reshaping for endovascular-graft fixation.

Abstract

Endovascular repairs of the aortic arch aneurysms require correct placement and an appropriate landing zone for fixation, which are not present in the majority of cases. We report a less invasive approach in 4 patients presenting an aortic arch aneurysm. We performed a hybrid procedure that is a combination of different techniques: a mid-sternotomy is performed, followed by transposition of the supra-aortic vessels, and neck reshaping with a proximal banding of the aortic arch. In particular, we banded the aorta to facilitate and optimize the endovascular fixation of the graft, reducing postoperative type-1 endoleaks. The four procedures were uneventful with 1-day intensive care unit recovery. The postoperative and the 1-year follow-up CT scan did not reveal any endoleaks. Hybrid technique, combined with banding of proximal aortic arch and endovascular grafting are an alternative technique to the conventional open aortic repair. A polyester cloth banding of the ascending and proximal aortic arch allow the neck reshaping of the aorta optimizing the fixation of the endovascular stent graft.