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Volume 47, Issue 6 , Pages 1195-1202 , June 2008

Surgical correction of failed thoracic endovascular aortic repair

Stephan Langer, MD
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
Gottfried Mommertz, MD
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
Thomas A. Koeppel, MD
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
Geert W.H. Schurink, MD
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
Rüdiger Autschbach, MD
- European Vascular Center Aachen-Maastricht, Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
Michael J. Jacobs, MD
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
- Correspondence: Michael Jacobs, MD, University Hospital Aachen, Department of Vascular Surgery, Pauwelsstrasse 30, 52074 Aachen, Germany.

Received 18 October 2007 ,Accepted 2 January 2008.

A, Computed tomography scan of patient 1 38 days after thoracic endovascular repair for acute type B dissection shows retrograde extension in the aortic arch. B, Intraoperative image after sternotomy

A, Computed tomography scan of patient 1 38 days after thoracic endovascular repair for acute type B dissection shows retrograde extension in the aortic arch. B, Intraoperative image after sternotomy shows the endograft in the descending thoracic aorta. The arch is already resected, and bypasses have been anastomosed to the innominate and left carotid artery. Antegrade cerebral perfusion is performed through the grafts.
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A, Patient 5 presented with an expanding distal arch and descending thoracic aneurysm. B, Image shows incomplete deployment and apposition of the endograft due to stiff fibrous septum (thick arrow). N

A, Patient 5 presented with an expanding distal arch and descending thoracic aneurysm. B, Image shows incomplete deployment and apposition of the endograft due to stiff fibrous septum (thick arrow). Note the prior to TEVAR implanted patent carotid–carotid bypass (thin arrow). C, A control magnetic resonance angiography 6 months after conversion shows conventional aortic arch and proximal descending thoracic aortic prosthesis.
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A, Patient 6 had endovascular type II endoleak repair. B, The backbleeding left subclavian artery was closed by means of a transbrachially introduced occluder device. C, A large type I endoleak occurr

A, Patient 6 had endovascular type II endoleak repair. B, The backbleeding left subclavian artery was closed by means of a transbrachially introduced occluder device. C, A large type I endoleak occurred despite a successfully placed occluder in the left subclavian artery before conversion.
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