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Total Arch Replacement with Frozen Elephant Trunk Technique for Aortic Arch Aneurysm Complicated with Left Subclavian Artery Aneurysm
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（Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, Kure, Department of Cardiovascular Surgery, Hiroshima University Graduate School of Medicine* Hiroshima, Japan, and Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine**Osaka, Japan）
| Taro Nakazato |
Teruya Nakamura |
Naosumi Sekiya |
| Naomichi Uchida* |
Yoshiki Sawa** |
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A 61-year-old man who had hypertension and renal dysfunction（serum creatinine:1.5-2.0mg/dl）was referred to our hospital for an abnormal shadow on chest roentgenogram. Chest CT scan with contrast revealed a distal aortic arch aneurysm（maximum diameter 52mm）and left subclavian artery aneurysm（maximum diameter 30mm). For the surgical treatment of the aneurysms, left hemi-collar incision and left subclavian incision followed by median sternotomy were performed. After the left subclavian artery was secured distal to the aneurysm, a ringed dacron graft was anastomosed with the distal left subclavian artery. Cardiopulmonary bypass was commenced, and selective cerebral perfusion was instituted at 25℃. The aorta was transected at the origin of the left common carotid artery. A 30mm stent graft（length 13cm）was inserted and was fixed on the transected aorta using 4-0 Prolene continuous suture. Then a branched dacron graft was sewn onto the transected aorta and the stent graft. The left common carotid artery and the brachiocephalic artery were anastomosed onto side branches of the graft. The left subclavian artery was reconstructed by anastomosing the ringed bypass graft onto one of the side branches. The left subclavian artery was ligated between the aneurysm and the origin of the vertebral artery, thereby interposing the subclavian artery aneurysm. After proximal anastomosis was done and the heart was reperfused, the patient was weaned from cardiopulmonary bypass. The patient was discharged without any major complication. Two years after the operation, the patient is doing well and there is no evidence of aneurysmal dilatation or endoleak. In conclusion, frozen elephant trunk technique provides an alternative to conventional graft replacement, resulting in complete exclusion of these aneurysms in a single stage. However, long-term follow up is warranted in order to ensure the durability of the stent graft.
Jpn. J. Cardiovasc. Surg. 41:113-116（2012）
Keywords：subclavian artery aneurysm, thoracic aortic aneurysm, frozen elephant trunk technique
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