Aortic arch

Question 1

Describe the 5 endovascular aortic arch landing zones

Answer 1

Question 2

Describe the three types of hybrid arch repair

Answer 2

Question 3

Describe the typical anatomy requiring type II hybrid arch repair

Answer 3

Question 4

Draw a hybrid type I aortic arch repair including a left subclavian artery bypass

Answer 4

Question 5

Give 7 steps in type II hybrid arch repair

Answer 5

1. CPB with ascending aorta or axillary artery cannulation
   2a. SVC cannula + cannula with snare if retrograde cerebral perfusion considered for TCA; LV vent via RSPV

OR

2b. R axillary exposure, 8mm graft, cannulate, CPB, X-clamp innominate artery during TCA
3. Ascending aortic (4 limbed) graft during X-clamping, just above ST-junction (to optimise landing zone)
4. TCA, transverse hemiarch anastomosis
5. Transfer aortic cannula to 4th limb of graft, restart CPB
6. Individual supra-aortic vessel ligation & anastomoses, from L to R
7. Place endograft antegradely (4th limb) or retrogradely (femoral)