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Ann Thorac Surg 2002;73:449
© 2002 The Society of Thoracic Surgeons

Invited commentary

^a Department of Cardio-Thoracic Surgery, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria

e-mail: martin.grabenwoeger{at}univie.ac.at

This is an excellent article on an important subject. Combined surgical and endovascular management is a promising approach for improved and extended repair of the thoracic aorta.

The authors describe three indications for the combined procedure: atherosclerotic aneurysms of the distal arch and proximal descending aorta, type B chronic dissections, and type A acute dissections. Two operative procedures are presented. Type 1 operations for thoracic arteriosclerotic aneurysms of the distal aortic arch TA and type B dissections included open stent grafting during deep hypothermia and circulatory arrest and left subclavian artery bypass from the ascending aorta, whereas type 2 operations involved open stent grafting with total arch and ascending aorta replacement.

The real benefit of an operation in deep hypothermia and circulatory arrest for aneurysms of the descending aorta can be considered when the ascending aorta and proximal arch are not affected. Endovascular stent grafting from the femoral artery with overstenting of the left subclavian artery could be a less invasive approach for this type of lesion. Subclavian to carotid artery transposition can be performed in advance or after the intervention, when necessary. In contrast, a combined procedure for aneurysms involving the ascending aorta, arch, and descending aorta offers the possibility of a complex repair of the aorta through median sternotomy, which is tolerated better than posterolateral thoracotomy.

Especially the treatment of type A acute dissections is markedly improved by stent grafting of the descending aorta. The development of chronic aneurysms of the descending aorta is hampered and the risk of rupture minimized.

Congratulations to Dr Uchida and colleagues on their innovative and interesting procedures.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Grabenwöger, M. Search for Related Content PubMed Articles by Grabenwöger, M. Related Collections Great vessels