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Archives of Medical Science
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2/2018
vol. 14
 
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abstract:
Letter to the Editor

Negative pressure wound therapy (NPWT) treatment of total supra-aortic debranching graft infection

Raffaello Bellosta, Luca Luzzani, Francesca Bontempi, Monica Vescovi, Antonio Sarcina

Arch Med Sci 2018; 14, 2: 466–469
Online publish date: 2016/04/27
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Endovascular treatment strategies for aortic arch disease have been increasingly prevalent over the last decade as a less invasive option for patients not eligible for conventional open repair, a procedure that is still associated with high complication and mortality rates [13].
Anatomical and pathological aortic arch peculiarities often require a hybrid approach to achieve an adequate proximal landing zone and preserve cerebral and spinal cord perfusion [4]. Various surgical options have been developed for revascularization of supra-aortic arteries, including partial or complete artery debranching with bypass reconstruction or transposition. Although these hybrid procedures represent an effective alternative for high risk patients, they are also associated with significant cardiac, neurological (stroke, intracerebral hemorrhage or spinal cord ischemia), and pulmonary renal complication rates [5, 6]. Endovascular stent graft infection is a rare complication of endovascular treatment. Among the many possible complications, supra-aortic graft infection in hybrid aortic arch repair has not been reported in the literature yet.
Patient consent to publish the data was obtained.
An Institutional Review Board (IRB) does not exist at our institution. The principles of the Declaration of Helsinki were followed.
A 75-year-old man presented with an asymptomatic 74 mm diameter aortic arch aneurysm; associated comorbidities were hypertension, obesity, chronic obstructive pulmonary disease and atrial fibrillation. Six years previously, the patient underwent open repair with an aorto-biiliac Dacron graft for an abdominal aortic aneurysm. Because of these comorbidities, a hybrid approach (open and endovascular) was chosen. A tomography (CT) scan showed a large arch aneurysm (74 mm diameter) involving the left subclavian artery (Figure 1).
To obtain an adequate landing zone (zone 0, according to the Ishimaru classification (7)) total supra-aortic trunk debranching was planned.
Through a median sternotomy, the ascending aorta and supra-aortic trunk were isolated. A side clamp was applied to the distal ascending aorta and an end-to-side anastomosis with a 10 mm Dacron graft was performed (C.R. Bard, Inc., Murray Hill, New Jersey, USA). A 7 mm and 8 mm trifurcated Dacron graft was tailored manually. Distal end-to-end anastomoses were then sequentially performed on the anonymous artery and the left common carotid artery. Revascularization of...


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