Aortic Arch & Thoracic descending Aorta Aneurysm

Findings on the chest radiograph may be rarely diagnostic of a ascending aortic aneurysm or a thoracic aortic aneurysm in general. CT scan with the use of contrast is the most widely used non invasive technique for diagnosing thoracic aortic disease. It provides information about size, location and extent of the aneurysm; it is of particular value in documenting the growth rate of aneurysms, determining timing of operative intervention in asymptomatic patients and evaluating patients postoperatively. Others diagnostic techniques are MRI, TEE and aortography.

The surgical treatment of the aortic arch aneurysm consists in excising the aneurysm and replace it with a prosthetic tube graft. The aortic arch replacement can be partial or total. The supra-aortic vessels, that carries the oxygenated blood to the brain and upper limbs, are sutured to the graft with a single arterial button or separately, using a branched graft. Hypotermic circulatory arrest with moderate hypotermia (26 Celsius degrees) should be established in case of aortic arch surgery with cerebral protection, most of the times, with bilateral perfusion during the circulatory arrest time. When the aneurysm involves more the just the very proximal descending thoracic aorta, a two-stage procedure may be considered. Surgical management of extensive arch disease involving the descending aorta can be achieved with an hybrid approach called "Frozen Elephant Trunk" (FET) which allows to to treat the combined disease of the arch and of the descending thoracic aorta at the same surgical time (one-stage approach) using an hybrid prosthesis composed of a proximal part consisting of a a vascular prosthetic graft and a distal part consisting of a self-expandable stent graft. In addiction, after performing FET technique, it is possible to use the stent graft as a landing zone for secondary endovascular extension. The aortic arch surgery surgical approach is performed with a traditional full median sternotomy.