Video

Video 1 Coronal views of the preoperative PET-CT confirming the presence of the endovascular infection by demonstrating intense avidity on the innominate artery and distal aortic arch.
Video 2 Axial views of the preoperative contrasted CT Aorta demonstrating the total arch and descending thoracic aorta endovascular repair with ZenithTM Arch and Alpha distal extension modular stents (Cook) finishing above the visceral segment. Note the residual chronic aneurysm sac within the descending thoracic aorta, without the presence of any endoleaks. Due to the stent graft infection there is a dislocation of the innominate artery stent branch and an expanding aneurysm on the same vessel.
Video 3 Intraoperative video showing the sequence of the operation highlighting the removal of the stent and infected material and further reconstruction of the aortic arch, proximal descending thoracic aorta and supra-aortic trunks using a Thoraflex PlexusTM (Terumo Aortic, Vascutek) with cardiopulmonary bypass, moderate hypothermic circulatory arrest and antegrade cerebral perfusion.
Video 4 Axial views of the postoperative contrasted CT Aorta, demonstrating a satisfactory aortic repair with a ThoraflexTM Plexus. The stented portion sits inside the previous stent of the descending thoracic aorta. The aortic arch was replaced with individual reimplantation of the right subclavian artery and both right and left common carotid arteries. Previous bypass from left subclavian to left common carotid noted. Note the presence of mild pericardial and bilateral pleural effusions at postoperative day 7.

Authors: Ana Lopez-Marco, Saleem Jahangeer, Benjamin Adams, Aung Ye Oo