Selective Cerebral Extracorporeal Circulation-Enhanced Total Endovascular Arch Replacement Using In Situ Fenestration

This video is part of CTSNet’s 2024 Resident Video Competition. Watch all entries into the competition, including the winning videos.  

Total arch surgery is the gold standard procedure for the repair of entry tears and false lumen-related complications in patients who have previously undergone surgery for acute type A aortic dissections. Although satisfactory outcomes have been described with acceptable survival rates for this complex surgery, it can be difficult to perform in frail patients due to the extremely invasive nature of arch surgery and the considerable adverse event rates. Treating these aortic pathologies in an endovascular manner poses another complex challenge, further complicated by the lack of commercially available devices in the region. In recent years, stent graft replacement techniques  
for arch pathologies have evolved, and debranching thoracic endovascular aortic repair interventions, along with additional modifications using chimney techniques and  
fenestrated stent grafts, may potentially be used in the aortic arch region pathologies. 

In this video, the authors suggested a newly designed selective cerebral perfusion-enhanced total endovascular arch replacement technique using in situ fenestration for the repair of residual aortic pathology after the repair of a type A aortic dissection.

References

1. Zhu L, Dong P, Du L, Xun K, Liu P, Lu X, et al. Thoracic endovascular aortic repair under venoarterial extracorporeal membrane oxygenation for acute aortic dissection patients:A case report. Front Cardiovasc Med 2023;10:1242124. doi:10.3389/fcvm.2023.1242124.
2. Lou X, Chen EP. Optimal cerebral protection strategies in aortic surgery. Semin Thorac Cardiovasc Surg 2019;31:146-52. doi: 10.1053/j.semtcvs.2019.01.001.
3. Katada Y, Kondo S, Tsuboi E, Rokkaku K, Irie Y,Yokoyama H. Endovascular total arch repair using in situ fenestration for arch aneurysm and chronic type A dissection. Ann Thorac Surg 2016;101:625-30. doi:10.1016/j.athoracsur.2015.07.032

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