2.2 Surgical method
According to the patient’s condition, 1 case was planned for the contemporaneous operation, and 5 cases for the staged operation plan (Table 2). details as follows:
In the first stage, a series of extra-anatomical bypass operations were performed. Choose Vascutek 16*30mm straight blood vessel intervascular 20mm ”Y” type artificial blood vessel end-to-side anastomosis, a small branch of ”Y” type artificial blood vessel end-to-side anastomosis with the main vessel, self-made three branches and abdominal aortic bypass vessel (Figure-2a) . The ascending aorta was grafted to the innominate artery, left common carotid artery, left subclavian artery, and abdominal aorta bypass through a combined thoraco-abdominal incision (Figure-2b). After all these bypass operations, the proximal aortic arch (between the innominate artery and the left common carotid artery) is disconnected. The stumps on both sides of the aortic arch were sutured continuously. After the thoracic incision is closed, a jejunostomy is performed to provide enteral nutrition.
After 2 to 4 weeks, the second stage of surgery will be performed. In 4 patients, the infected TEVAR stent was removed through the left thoracic incision (Figure 3-a) and the ruptured esophagus was repaired (Figure 3-b). One patient had a large esophageal fistula and was difficult to repair. Partial esophagus resection was performed.