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Ann Thorac Surg 2002;74:S1825-S1832
© 2002 The Society of Thoracic Surgeons

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Session 2: Aortic and Endoluminal Stents

Discussion: Session 2—Aortic Arch Aneurysm and Endoluminal Stents

Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.

The first 300 words of the full text of this article appear below.

MR STEPHEN WESTABY (Oxford, England): With regard to the presentation from Mt. Sinai, I know their preference used to be to put the three head vessels (the brachiocephalic vessels) together on one graft and reimplant them on a Carrel button, and now they have gone on to sectioning the separate vessels. Is this making a difference? Is it not just making it more complicated?

DR DAVID SPIELVOGEL (New York, NY): The reason we moved to this technique is that we found that, when using the Carrel patch technique in elderly patients, the origins of the brachiocephalic vessels were often very diseased. And we found that we were spending a lot of time trying to remove the atherosclerotic plaques and loose debris, and that perhaps this was contributing to some of our strokes. But we also noticed that if you went just a centimeter or two above, to the brachiocephalic vessels themselves, that they were often free and soft, with no disease.

Intuitively you would say, why don’t we just move our resection just a little further north and use a trifurcated graft or a bifurcated graft depending upon the situation. I have to admit that part of our motivation came from a video that was presented at the last symposium by Dr Taniguchi. He developed a technique where he constructed his elephant trunk in the distal ascending or mid arch, away from the nerves, with the idea that this would reduce the morbidity associated with respiratory failure and prolonged intubation. And then we thought, why not move our resection also to the brachiocephalic vessels and move some of our elephant trunks to the mid arch, and avoid the nerves and the morbidity associated with recurring laryngeal nerve palsy? So I think that in the population where you have a lot . . . [Full Text of this Article]

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