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Use of the Abdominal Aorta as an Alternative Access Site for Thoracic Aortic Stent Graft Placement

Jobst Vascular Center, The Toledo Hospital, Toledo, Ohio

John P. Pigott, MD

Jobst Vascular Center, The Toledo Hospital, Toledo, Ohio

Anthony J. Comerota, MD, RVT

Jobst Vascular Center, The Toledo Hospital, Toledo, Ohio, Department of Surgery, University of Michigan, Ann Arbor, Michigan, marilyn.gravett{at}promedica.org

The treatment of thoracic aortic pathology has undergone a paradigm shift in recent years, with a trend toward less invasive endovascular techniques and away from open surgical repair. Reports on the successful use of endografts in the thoracic aorta have demonstrated decreased morbidity and mortality of these procedures compared with traditional open repair. However, some patients are not candidates for an endovascular approach because of a short proximal landing zone, arch angulation, luminal irregularities, or a large diameter of the transverse arch and the proximal descending aorta. Other patients are excluded because of distal pathology or anatomic irregularities. This article presents 2 patients with thoracic aortic pathology, and both had inadequate proximal landing zones and small, calcified iliac arteries prohibiting femoral or iliac access. Successful repair of these patients was achieved by a staged procedure using a brachiocephalic debranching technique, followed by direct infrarenal aortic cannulation through a limited celiotomy.

Key Words: thoracic aorta • thoracic endografts • surgical debranching

This version was published on January 1, 2009

Vascular and Endovascular Surgery, Vol. 42, No. 6, 574-578 (2009)
DOI: 10.1177/1538574408320170


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