Combined internal and external blood shunt technologies for the in-situ three-fenestration revascularization of aortic arch

Objective To summarize the brain protection application experiences of combined internal and external blood shunt technologies for the in-situ three-fenestration revascularization of aortic arch. Methods From Feb 2017 to Jun 2018, 8 patients with aortic arch leisons were treated by the in-situ three-fenestration techniques, including 3 aortic dissection, 2 aortic aneurysm, 3 postoperative TEVAR patients .We adopt the method of internal and external blood shunt technologies for brain protection using the vascular sheath for fenestration combined with carotid shunt tube skills, and used TCD to monitor the blood flow of brain. Results All operations completed successfully, and TCD showed no significant cerebral ischemia when aortic stent was used to cover the three branches of the aortic . The mean time of brain protection was (17.62±6.87) minutes. One patient developed transient cerebral ischemia after surgery, and another one developed cerebral infarction. Conclusions The brain protection strategy of internal bypass combined with external converter technology maintain the brain blood flow, while is simple and feasible, it cannot completely avoid neurological complications. Key words: Aortic diseases; Stents; Brain protection; Shunt