Type 2: the “prophylactic debranching”
The distal tail of the arch prosthesis is simply left uncut, or barely
shortened. This branch-free segment will actually replace the arch (zone
0C-2). Therefore, the branched portion of the graft will be dislocated
proximally (zone 0A-B). Distal anastomosis will be performed at distal
aortic stump site with a 3.0 polypropylene continuous suture, reinforced
with both endo-luminal and peri-adventitial Teflon felt strip.
Subsequent surgical steps are superimposable to those described for type
1 repair. The final aspect will be similar to a conventional arch
debranching, with the three supra-aortic vessels originating from the
ascending tract. The prosthetic arch, freed from all collaterals, will
serve as a landing zone for subsequent TEVAR (Fig. 3). Proximal repair
is then completed as requested.