Total Arch Replacement Using Open Stent Graft with Angioscopy Guidance for Pseudoaneurysm Following Descending Aortic Replacement: A Case Report

Abstract

An 87-year-old man, who had undergone descending aorta replacement because of aneurysm rupture, required emergent surgery for a pseudoaneurysm at the proximal anastomosis of the graft. The preoperative computed tomography scan revealed that the existing graft was severely kinked, and that additional aortic aneurysms were present at the distal sites. We judged it difficult to perform thoracic endovascular aortic replacement approaching from a peripheral artery, such as the iliac or femoral artery, because of these lesions, and selected total aortic arch replacement using an open stent graft method. Although we attempted to use the transesophagus echocardiography as the intraoperative guidance of the distal end of the stent graft, we were unable to insert the echo probe through the esophagus. We accomplished the effective deployment of the open stent graft after confirmation of its distal end and determination of satisfactory expansion using angioscopy as an alternative guidance mechanism.