Cerebral Protection With a Crossover External Carotid Artery Bypass During Arch Debranching

Uğurlucan, Murat; Sayın, Ömer Ali; Önalan, Mehmet Akif; Alishev, Nijat; Başaran, Murat; Alpagut, Ufuk; Dayıoğlu, Enver

doi:10.1016/j.athoracsur.2014.07.089

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…As in our patient, the distal aortic arch lesions, that is, zones 2 and 3 [10], may require coverage of the left carotid and subclavian artery orifices for a successful stent graft placement and exclusion of the aneurysm. It may be necessary to revascularize these arteries before a TEVAR, which will include the aortic arch [4, 11, 12]. Our group has invented a novel debranching procedure: cerebral protection with a crossover bypass between right and left external carotid arteries which provides pulsatile blood flow to the brain despite proximal arterial clamp on the consecutively clamped carotid arteries and therefore minimizes the neurologic complication rates [4, 5].…”

Section: Discussionmentioning

confidence: 99%

“…It may be necessary to revascularize these arteries before a TEVAR, which will include the aortic arch [4, 11, 12]. Our group has invented a novel debranching procedure: cerebral protection with a crossover bypass between right and left external carotid arteries which provides pulsatile blood flow to the brain despite proximal arterial clamp on the consecutively clamped carotid arteries and therefore minimizes the neurologic complication rates [4, 5]. Revascularization of the left subclavian artery may not be necessary in many instances.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral protection is very important to prevent stroke. We provided continuous pulsatile flow in internal carotid arteries despite proximal clamping with temporary bypass between external carotid arteries in our case [Ugurlucan's cerebral protection technique during aortic arch debranching [4, 5]] for aortic arch debranching and successful exclusion of the aneurysm confined to the thoracic aorta. In addition, as in our case for the failing TEVAR procedures due to inappropriate sized arterial access, additional hybrid procedure can be performed to facilitate the TEVAR [14] and to treat accompanying compromising pathologies.…”

Section: Discussionmentioning

confidence: 99%

“…Aortic arch debranching was performed according to Ugurlucan's technique [4, 5]. The operation was performed with the left cervical and subclavian infiltration anesthesia and right cervical regional block.…”

Section: Surgical Techniquementioning

confidence: 99%

“…No cerebral ischemic period occurred during or after the procedure. Pulsatile flow in the internal carotid arteries was never interrupted [4]. …”

Section: Surgical Techniquementioning

confidence: 99%

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Case Reports in Medicine

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Treatment of thoracic aortic aneurysms constitutes high mortality and morbidity rates despite improvements in surgery, anesthesia, and technology. Endovascular stent grafting may be an alternative therapy with lower risks when compared with conventional techniques. However, sometimes the branches of the aortic arch may require transport to the proximal segments prior to successful thoracic aortic endovascular stent grafting. Atherosclerosis is accounted among the etiology of both aneurysms and occlusive diseases that can coexist in the same patient. In these situations stent grafting may even be more complicated. In this report, we present the treatment of a 92-year-old patient with aortic arch aneurysm and proximal descending aortic aneurysm. For successful thoracic endovascular stent grafting, the patient needed an alternative route other than the native femoral and iliac arteries for the deployment of the stent graft. In addition, debranching of left carotid and subclavian arteries from the aortic arch was also required for successful exclusion of the thoracic aneurysm.

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