Acute Type A Aortic Dissection—Replacement of Ascending Aorta, Aortic Arch and Antegrade Stenting of the Descending Thoracic Aorta Using the Thoraflex™Hybrid Plexus Device (Terumo Aortic)—“Frozen Elephant Trunk”: The Plymouth Way!

Objectives: To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. Materials: Thoraflex™ Hybrid Plexus Device (Terumo Aortic). Design: Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. Method/ Results: Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. Conclusions: We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.

Steel wire causing pseudoaneurysm of descending aorta

An l l-years-old boy presented with 7 days history of abdominal pain, precordial pain and intermittenthematemesis. The physical examination revealed appearance of anemia, precordial tenderness without other positive findings. Routine blood test was notable for Hb 60 g/L. Contrast CT scan of the chest revealed a soft tissue dense mass close to the descending aorta （Figure 1 A and B）. The mass and the adjacent artery were luminally connected and intensified substantially at the same time and to the same degree on the radiographic studies. The wall of the mass was slightly thickened and the inner surface of the wall was not smooth. The esophagus was deviated and became narrow due to compression （Figure 1 A）. Axial maximum intensity projection （MIP） showed a linear metallic foreign body （Figure I C） and local airway moved forward and became flat. Volume rendering （VR） confirmed a right- side protruding mass adjacent to the beginning of the descending aorta （Figure 1 D）. The gastroscopy showed ulceration of the esophageal mucosa （Figure 1 E）.

Endovascular repair of a tuberculous aneurysm of descending thoracic aorta

Tuberculous aortic aneurysm （TBAA） is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial,endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication.The outcome was favorable.