R. DE SILVA ET AL.
Copyright © 2011 SciRes. SS
337
Figure 2. 3-D CT reconstruction of the ascending, arch and
descending aorta, showing the aneurysm (A), and the 3
conduits anastamosed to the branc hes of the aortic arch (I =
innominate artery conduit, C = left common carotid artery
conduit, S = left subclavian artery c o nduit).
the aneurysm, which eliminates the risk of type II en-
doleaks in this area. Although ligating normal arteries
would seem counterintuitive, if left patent the backflow
following TEVAR will eventually leave the patient at th e
risk of aneurysm rupture, negating any prognostic benefit
of intervention.
Our technique does not need circulatory support with
its possible complications. Despite the many advantages
of cardiopulmonary bypass, it can also cause significant
morbidity, especially the associated inflammatory re-
sponse and coagulopathy. By addressing the arch vessels
sequentially, ligating the vessels only after completion of
the debranching, and careful haemodynamic manage-
ment by the anaesthesiologist, we have managed to do
this procedure without the help of cardiopulmonary by-
pass. This makes the concept of hybrid surgery even
more attractive than the open surgical alternative, which
also requires a period of hypothermic circulatory arrest.
Overall, our modified technique of hybrid aortic
debranching allows the surgeon to perform the procedure
with relative ease, so that the patient may have an expe-
ditious recovery and proceed to TEVAR.
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