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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2009.09.022 Byline: Ludovic Canaud, Kheira Hireche, Jean-Philippe Berthet, Pascal Branchereau, Charles Marty-Ane, Pierre Alric Abbreviations: ASA, American Society of Anesthesiologists; BT, brachiocephalic trunk; LCCA, left common carotid artery; LSA, left subclavian artery Abstract: The aim of this study was to assess the short- and midterm results after endovascular repair of the aortic arch in high-risk patients or after previous aortic surgery. Author Affiliation: Department of Vascular and Thoracic Surgery Arnaud de Villeneuve Hospital, Montpellier, France Article History: Received 13 March 2009; Revised 30 July 2009; Accepted 8 September 2009 Article Note: (footnote) Disclosures: None.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2009.06.017 Byline: Ludovic Canaud (a), Pierre Alric (a), Pascal Desgranges (b), Jean Marzelle (b), Charles Marty-Ane (a), Jean-Pierre Becquemin (b) Abbreviations: CT, computed tomography; TEVAR, thoracic endovascular aortic repair Abstract: Our objective was to assess potential causative factors of stent-graft collapse after thoracic endovascular aortic repair. Author Affiliation: (a) Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France (b) Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France Article History: Received 2 May 2009; Revised 3 June 2009; Accepted 20 June 2009 Article Note: (footnote) Disclosures: None.

Objective/HypothesisDescending necrotizing mediastinitis is caused by downward spread of neck infections and constitutes a highly lethal complication of oropharyngeal lesions. This infection previously had a much worse prognosis. In recent years, more aggressive management has been recommended. The aim of this study is to evaluate the results with the association of thoracotomy and cervicotomy, medical care in an intensive care unit, and daily washing of drained cervical and thoracic tissues.

Purpose: To compare the proximal fixation characteristics of different types of stent-grafts (SG) and the adjunctive effect of a proximally placed Palmaz stent.Methods: Human cadaveric aortas were obtained at autopsy and cut into 30 aortic segments. Appropriately oversized (10% to 20%) commercial stent-grafts (Zenith, Ancure, Excluder, Talent) and 4 configurations of homemade Palmaz-based stent-grafts (polytetrafluoroethylene or polyester coverings each with no uncovered proximal edge or a 20-mm bare section of stent) were implanted 20 mm into an aortic segment and balloon dilated. Each segment was placed in an experimental apparatus to measure the dislodgment force. Bare Palmaz stents were used to reinforce the proximal fixation of the commercial stent-grafts, and the measurements were repeated. Manual anastomoses were made and their dislodgment force tested for comparison.Results: The median dislodgment force ranged from 6.5 N for the Excluder to 26.5 N for the Zenith (8.0 N for the Talent, 11.8 N for the Ancure, and 8.1 to 10.7 N for the various Palmaz stent-graft designs). There was no significant difference between the Zenith and the Ancure groups or between the Excluder and the Talent groups. However, the Zenith and Ancure devices required significantly higher (p = 0.0004) force (∼25%) to displace them than the other stent-grafts tested. With the Palmaz stent added to the proximal attachment site, the median dislodgment force for the different commercial endografts was significantly improved for all devices (p < 0.03): 34% for the Zenith device, 69% for the Ancure, 73% for the Talent, and 80% for the Excluder endoprosthesis.Conclusions: The Zenith stent-graft had the best resistance to dislodgment. An additional Palmaz stent placed at the proximal attachment site greatly improves endograft fixation regardless of the type of stent-graft. For complex aneurysm necks or for intraoperative type I endoleak management, an adjunctive Palmaz stent could be used.