• Martin Czerny, Daniel Zimpfer, Tatjana Fleck, Wolfgang Hofmann, Maria Schoder, Manfred Cejna, Paul Stampfl, Johannes Lammer, Ernst Wolner, and Martin Grabenwoger.
• Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria. bypass@eunet.at
• Ann. Thorac. Surg. 2004 Oct 1; 78 (4): 1256-60.

BackgroundTo evaluate safety and efficacy of a combined repair of aortic arch aneurysms by sequential transposition of the supra-aortic branches and endovascular stent-graft placement.MethodsBetween October 2002 and September 2003, 5 patients (mean age, 79.5 years) presented with aortic arch aneurysms involving the origin of the left carotid artery. Treatment was made by sequential transposition of the left carotid artery into the brachiocephalic trunk and transposition of the left subclavian artery into the already transposed left common carotid artery with consecutive endovascular stent-graft placement into the aortic arch.ResultsAll patients survived both procedures. At completion angiography, a small type 1a endoleak was observed in 1 patient. After 1 week, the patient was readmitted for completion three-dimensional computed tomographic scan. The leak had already occluded spontaneously. Mean follow-up was 10 months (range, 4 to 16 months). At follow-up, all patients had normal computed tomographic scans with regular perfusion of the supra-aortic branches without any signs of endoleaks.ConclusionsCombined repair of aortic arch aneurysms by sequential transposition of the supra-aortic branches with consecutive endovascular stent-graft placement is feasible. Extended application of this technique will enable safe and effective treatment of a highly selected subgroup of patients with aortic aneurysms by avoiding conventional arch aneurysm repair in deep hypothermia and circulatory arrest.

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