Supraaortic bypass reconstructions using ring-reinforced 8 mm polytetrafluoroethylene (PTFE) for debranching prior to TEVAR and for atherosclerotic lesions of the subclavian artery

Figures

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  Fig 1. A, Three-dimensional (3D)-reconstruction of a computed tomography (CT)-angiography of a supra-aortic reconstruction with a ring-reinforced 8 mm polytetrafluoroethylene (PTFE) carotid-subclavian and a carotid-carotid bypass in a 78-year-old male patient with an aortic arch aneurysm who required endovascular repair. This CT-angiography has been performed 6 years and 3 months after the bypass reconstructions, currently showing no evidence of an anastomotic stenosis or bypass occlusion. B, 3D-reconstruction of a CT-angiography of a supra-aortic reconstruction with a ring-reinforced 8 mm PTFE carotid-subclavian bypass in a 78-year-old male patient with an aortic arch aneurysm. The CT-angiography has been performed 3 months after the bypass reconstructions, currently showing no evidence of an anastomotic stenosis or bypass occlusion. C, Triplex sonography of a supra-aortic reconstruction with a ring-reinforced 8 mm PTFE carotid-subclavian in a 52-year-old female patient with a thoracic aortic aneurysm and an aneurysm of the aortic arch, showing the carotid-subclavian bypass with a triphasic Doppler waveform and a flow of 1.43 m/s in the bypass. D, Triplex sonography of a supra-aortic…

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  Fig 2. Intraoperative view of an already created ring-reinforced 8 mm polytetrafluoroethylene (PTFE) carotid-subclavian bypass and the anastomosis to the left common carotid artery of the upcoming ring-reinforced 8 mm PTFE carotid-carotid bypass in a 68-year-old male patient receiving a debranching procedure before thoracic endovascular aortic repair (TEVAR). Note the lateral (side-to-end) bypass insertion of the carotid-subclavian bypass into the left common carotid artery and the medial (side-to-end) insertion of the carotid-carotid bypass into the left common carotid artery. Pretracheal tunneling of the carotid-carotid bypass will subsequently be performed directly posterior of the jugular notch. There were no complications at the surgical site noted in any of our patients.

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  Fig 3. Kaplan-Meier curves demonstrating cumulative primary patency rates (blue line) and overall survival rates (red line) over a 72-month follow-up period. Vertical ticks indicate censored observations. The number of bypasses at risk for each time interval is provided in the table below the horizontal axis.