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Total endovascular aortic arch reconstruction via fenestration in situ with cerebral circulatory support: an acute experimental study^,

^a Department of Interventional Radiology, Cerrahpaa Medical Faculty, Istanbul University, Istanbul, Turkey
^b Department of Cardiovascular Surgery, Memorial Hospital, Istanbul, Turkey
^c Endovascular Innovations, Medtronic CardioVascular, Santa Rosa, CA, USA
^d Department of Cardiovascular Surgery, University Hospital of Geneva, Switzerland

*Corresponding author. Memorial Hastanesi Piyalepasa, Bulv. Okmeydani Sisli, 34385 Istanbul, Turkey. Tel.: +90 212 3146666, +90 212 2208910; fax: +90 212 3146644.

E-mail address: harbatli{at}yahoo.com, harun.arbatli{at}memorial.com.tr (H. Arbatli).

The aim of this experimental study is to evaluate the feasibility of endovascular repair of the complete aortic arch by using novel fenestration devices with simultaneous support of the cerebral circulation. Two fresh human cadavers and five Yorkshire pigs were used for the experiments. In human cadavers the thoracic aorta was pressurized using a roller pump to simulate the circulation. In animal experiments right femoral artery to right distal carotid artery bypass circuit was achieved in order to support the cerebral circulation during the stent graft deployment, fenestration and conduit fixation procedures. Commercially available Valiant Thoracic Stent Grafts, covered stents, steerable guiding catheters and dilatation balloons were used. Stent grafts were deployed successfully and two fenestrations and one conduit implantation were achieved in each cadaver. All animals survived the stent graft implantation, fenestration and conduit implantation procedures. Cadaver dissection and necropsy of the animals revealed good fixation of the conduits into the fenestrated segments of the stent graft. Endovascular repair of the total aortic arch via in situ fenestration of the stent graft using cerebral circulatory support seems to be feasible and safe. Further studies are required before clinical adoption of this procedure.

Key Words: Aortic arch aneurysm; Endovascular stent graft; Cerebrovascular circulation