Complex Arch Reconstruction
A variety of strategies can be employed to replace the arch, and tailored to the individual pathology and clinical condition of the patient, as shown above. It is possible to debranch sections of the aortic arch and replace those with trifurcated grafts. Each patient is different and Dr Babar Bashir CHAUDHRI can provide an individualised and bespoke solutions, where necessary.
Hybrid Elephant Trunk Procedure
Anatomic Illustration of Two-Staged Procedure
The hybrid elephant trunk procedure is one commonly used complex aortic operation recommended for patients who have extensive aortic aneurysms as well as several coexisting medical conditions, particularly respiratory problems. The elephant trunk procedure is a two-stage procedure used to treat extensive aneurysms involving both the ascending aorta and aortic arch, and the descending thoracic or thoracoabdominal aorta.
In the first stage, an incision in the sternum is used to replace the aortic valve, ascending aorta and arch, and an “elephant trunk” graft is placed that hangs in the descending aorta.
During the second-stage procedure, a stent graft is placed by using an endovascular approach through the femoral artery to connect the elephant trunk to the lower wrap graft.
In other cases, an additional incision may be required to place an extra graft to another part of the aorta.
Stage 1: Elephant Trunk Procedure for complex aortic aneurysm
Stage 2: Elephant Trunk Procedure for complex aortic aneurysm
Surgeons are now able to treat some thoracic and thoracoabdominal aneurysms with a promising, new procedure called an endovascular stent graft.This means that surgery is performed inside the body using thin, long catheters. Through small incisions in the groin, the catheters are used to guide a stent graft through the blood vessels to the site of the aneurysm. An endovascular stent graft is a small, wire mesh tube that reinforces the weak spot in the aorta. By sealing the area tightly with the artery above and below the aneurysm, the graft allows blood to pass through it without pushing on the aneurysm.
Endovascular repair of thoracic aneurysms is generally less painful and has a lower risk of complications than traditional open-chest surgery because the incisions are smaller. The use of endovascular stent grafts is particularly beneficial for those patients who are not candidates for open-chest surgery, due to the risks it presents.
Ascending and Descending Aortic Aneurysm Repair
Complex aortic procedures treat patients with aneurysms that need replacement of the aorta from the aortic valve down to the aortic bifurcation (where the aorta separates into two).
The axillary artery is used to provide ongoing blood perfusion to organs during aortic aneurysm repair and when atherosclerosis (plaque) is present in the ascending aorta.
During the procedure, the axillary artery (the part of the main artery of the arm) is used to provide ongoing blood perfusion to the body’s organs, and is also used when atherosclerotic plaque is present in the ascending aorta.