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Arch Replacement Without Hypothermic Circulatory Arrest for Type Ia Endoleak: How We Do It In Ancona

Monday, May 18, 2020

Di Eusanio M, Cefarelli M, Alfonsi J, Berretta P, Gatta E. Arch Replacement Without Hypothermic Circulatory Arrest for Type Ia Endoleak: How We Do It In Ancona. May 2020. doi:10.25373/ctsnet.12320696

Type Ia endoleak represents a major complication after TEVAR implantation (1). The treatment of choice to obtain the closure of the proximal leak includes a) total arch replacement with a distal suture taking the native distal aorta, the stentgraft, and the arch graft, and b) total arch replacement with frozen elephant trunk (2). While such techniques have been associated with satisfactory outcomes, they do not avoid prolonged hypothermic circulatory arrest (HCA), which represents a main cause of postoperative mortality and morbidity. At the Lancisi Cardiovascular Center, the mutual exchange of knowledge between cardiac and vascular surgeons led to the development of an arch replacement hybrid technique that avoids hypothermia and circulatory arrest. The keys elements of this strategy include a) ballon endoclamping of the previously implanted endograft, and b) continuous cerebral and distal body perfusion from the femoral and innominate arteries. The aim of this video is to show the authors’ approach in a step-by-step fashion.


  1. Millen AM, Osman K, Antoniou GA, McWilliams RG, Brennan JA, Fisher RK. Outcomes of persistent intraoperative type Ia endoleak after standard endovascular aneurysm repair. J Vasc Surg. 2015 May;61:1185–1191.
  2. Di Bartolomeo R, Cefarelli M, Folesani G, Di Eusanio M. Frozen elephant trunk surgery using the Vascutek Thora-flex hybrid prosthesis. Ann Cardiothorac Surg. 2013 Sep;2(5):660-662.


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Congratulations on this nice technique and video. To which temperature are you cooling? Do you advance the balloon under TEE guidance or do you use fluoroscopy? Thanks.

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