Semi-Clamshell Approach with Rib-Cross for Infected Hybrid TEVAR

TL;DR

A new surgical approach is proposed for removing infected stent grafts in aortic repair, offering better visibility and protection during complex procedures.

Contribution

The semi-clamshell approach with rib cross is introduced as a viable method for infected hybrid TEVAR explantation.

Findings

The semi-clamshell approach provides clear visualization of the ascending aorta, aortic arch, and descending aorta.

The method offers reliable cerebral and myocardial protection during infected stent graft removal.

It is suitable for total arch and distal descending aorta replacement in open conversion of hybrid TEVAR.

Abstract

A single-stage extensive aortic replacement is necessary for infected stent graft explantation after thoracic endovascular aortic repair (TEVAR). However, establishing selective cerebral perfusion and antegrade myocardial protection while ensuring a clear view of the distal aorta is challenging. We adopted a semi-clamshell approach with rib cross for a case of infection following hybrid TEVAR. This approach provides visualization of the ascending aorta, aortic arch, and the descending aorta down to the diaphragm. It is a viable option for cases requiring total arch and distal descending aorta replacement, offering reliable cerebral and myocardial protection, particularly in open conversion of hybrid TEVAR.

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