Distal arch aneurysm repair using stent-grafting and ascending aorto-left axillary bypass

Background Transcatheter application of a stent-graft to the angulated aort ic segments with critical side branches poses some problems. We report our technique of distal arch aneurysm repairs using stent-grafts inserted throu gh the aortic arch and ascending aortoaxillary bypass. Patients and Results; Three patients underwent successful distal arch aneur ysm repair using a homemade semiflexible stent-graft placed under hypotherm ic circulatory arrest. The left subclavian artery was reconstructed by an e xtraanatomic bypass grafting between the ascending aorta and left axillary artery. Postoperative imaging demonstrated reduction of aneurysm size and n o endoleaks from an intercostal artery. Conclusions. Our technique seems to be useful for repair of distal arch ane urysms and is a less invasive procedure. (Ann Thorac Surg 2000;70:1974-6) ( C) 2000 by The Society of Thoracic Surgeons.