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Double-Barreled Cannon Stent Grafts: Possible Solution for Extremely Dilated Landing Zone of Aorta

https://doi.org/10.1016/j.athoracsur.2011.01.023Get rights and content

Anatomical limitations have been identified as barriers to the more widespread application of thoracic endovascular aortic repair. Here, we report a case in which a novel technique was used as a solution for an extremely dilated aortic landing zone. An elderly gentleman in profound shock was diagnosed with a ruptured distal aortic arch aneurysm. Open repair was considered, but owing to the presence of multiple comorbidities and an extremely dilated aorta in the landing zone (45 mm) which made thoracic endovascular aortic repair infeasible, it appeared to entail a high risk for perioperative morbidity and mortality. Therefore, to save the patient's life, we designed a novel double-barreled cannon thoracic endovascular aortic repair method, and further developed a formula for choosing appropriate stent graft sizes. The patient gradually recovered to baseline physical status after the operation.

Section snippets

Technique

An 84-year-old man presented at our hospital with desaturation and profound shock. A chest computed tomography scan with contrast revealed a distal aortic arch aneurysm up to 78 mm in diameter, with signs of leakage resulting in left hemothorax (Fig 1A). The patient had many significant comorbidities, including valvular heart disease in the status post-aortic valve and mitral valve replacements with mechanical valves, congestive heart failure with New York Heart Association functional class IV

Comment

The chimney technique has been often applied for proximal descending TAAs and visceral abdominal aortic aneurysms in situations with short, or even no landing zones, with acceptable surgical results [3, 4]. Nevertheless, owing to the shortage of larger size stent grafts when an extremely dilated aorta is encountered, it is often inevitably necessary to perform traditional surgery, or hybrid surgery, to band the dilated aorta of these patients. However, many of these patients are already in

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Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.