FROZEN ELEPHANT TRUNK WITH DEBRANCHING TECHNIQUE: ALTERNATIVE MANAGEMENT OF COMPLEX AORTIC ANEURYSM

Part 1 1. Cannulations of the right auxiliary artery  2. Aortic Cross-clamping 3. Resection of the Ascending aorta  4. Proximal anastomosis of the GPE graft at the level of sino-tubular junction of the aortic root, being careful to give the right angle to the prosthesis: the branches of the anonymous trunk and left common carotid artery must be tilted toward the superior vena cava.  5. Once the patient temperature reaches the 26 ° C proceed with the circulatory arrest and the clamping of the anonymous trunk, then, the right carotid artery will be perfused  through the cannula placed in the right axillary artery (8 ml (kg / min), two separate cannulas will provide the perfusion of the left carotid artery and the left subclavian artery (10 ml / kg / min)  6. Resection of the aortic arch  Part 2 1. recovery of the guide wire  2. Introduction of the E-Vita Open Plus Stentgraft 3. Deployment of the stentgraft; and anchoring to the aorta with polypropylene 2-0 or 3-0 suture  4. Recovery of the vascular prosthesis, resection of the fabric close to the anchoring suture already performed  5. Distal anastomosys between the GPE and the Stentgraft with 3-0 polypropylene suture  Part 3 1. Cannulation throught the perfusion branch of the vascular prosthesis  2. Re-Start of systemic perfusion, The selective anterograde cerebral perfusion is still running throught the cannulas 3. Execution of the one by one anastomosis for sovra-aortici trunks / anonymous trunk, common left carotid artery and left subclavian artery,  4. removal of the cannula