2015 Volume 24 Issue 7 Pages 975-979
A 82-year old man with edema of lower extremities and dyspnea on effort was admitted to our hospital. Computed tomography showed multiple aneurysms, a 80-mm aneurysm of the distal aortic arch, a 75-mm aneurysm of the descending aorta, and a 53-mm aneurysm of the abdominal aorta with moderate left pleural effusion. The one-staged hybrid treatment, total arch replacement using open-stent grafting technique and “Antegrade” TEVAR, was selected considering of the following problems, frailty, interval rupture of two-staged treatment, and unsuitable access for “Retrograde” TEVAR. The operation was performed with median sternotomy. After the induction of circulatory arrest in moderate hypothermia, selective cerebral perfusion was initiated. Total arch replacement using handmade open-stent graft was performed. After weaning of cardiopulmonary bypass, “Antegrade” TEVAR was performed from the side-branch of the 4-branched graft. The postoperative course was uneventful with no cerebral complication or spinal cord injury. Recent development of endovascular treatment causes various options for high-aged patients with complex thoracic aortic aneurysm. In our successful case, “Antegrade” TEVAR was particularly efficient.
