Surgical treatment for chronic dissecting aneurysm (DeBakey Type I) —A case using “elephant trunk” and “aortic tailoring”—
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We present a surgical case of a 54-year-old man with chronic dissecting aortic aneurysm (Type I). At the first operation, ascending aorta and aortic arch were replaced with a tube graft under cardiopulmonary bypass and selective cerebral perfusion. Elephant trunk method was employed for the second operation. At the second operation, graft replacement of the proximal two-thirds of the descending aorta was performed, and the lower third of the descending aorta was tailored. Aortic tailoring consisted of the longitudial aortomy and the removal of the intimai flap from the distal part of the descending aorta from the level of the 9th intercostal artery down to the diaphragm. The aorta was closed creating single channel 21 mm in diameter and containing the origins of the important intercostal arteries. He discharged the hospital without any complication including paraplegia or visceral ischemia, and his follow-up CT scan (1 year-later) did not show any dilatation of the tailored segment of the descending aorta and abdominal aorta.
KeywordsAortic Aneurysm Intercostal Artery Intimal Flap Elephant Trunk Selective Cerebral Perfusion
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- 2).Crawford ES, Svensson LG, Coselli JS, Safi HJ, Hess KR: Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. J Thoracic Cardiovasc Surg 98: 659–674, 1989Google Scholar
- 3).42: 2285–2291, 1994Google Scholar
- 5).Borst HG, Frank G, Schaps D: Treatment of extensive aortic aneurysms by a new multiple-stage approach. J Thoracic Cardiovasc Surg 95: 11–13, 1988Google Scholar
- 6).39:336–340, 1991Google Scholar
- 7).Kirklin JW, Barrat-Boyes BG: Cardiac surgery. 2nd ed., New York, 1993, Churchill Living-stone, Inc., p1765–1766Google Scholar
- 11).Griepp RB, Ergin MA, Gella JD: Looking for the artery of Adamkiewicz. A quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta. J Thoracic Cardiovasc Surg 112: 1203–1215,1996Google Scholar
- 13).Christopher DS, Peter SG, Vincent LG, Steve F, Melville W: Single-stage repair of distal aortic arch and thoracoabdominal dissecting aneurysms using aortic tailoring and circulatory arrest. Ann Surg 57: 580–587, 1994Google Scholar