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Figure 17.3. The Djumbodis dissection system is an uncovered stent graft that can be positioned in the aortic arch to facilitate coaptation of the aortic layers.

Aortic Dissection Uncovered Stent
Figure 17.4. Intra-aortic view showing the Djumbodis dissection system superimposed over the origin of the supra-aortic trunks.

serted in the aortic arch during moderate hypothermic circulatory arrest and secured to the aortic wall with transfixing stitches.

This system has been further developed by using a traditional transfemoral artery stent grafting of the thoracic aorta65. In an effort to improve the closure of the distal false lumen, other combined endovascular-surgical approaches have been proposed (such as a transaortic stent-graft implantation into the descending aorta during ascending and aortic arch replacements)52,53. Both these series have reported an 80% clotting of preoperatively patent false lumen at six months follow-up. This combined surgical and endovascular procedure seems to be a feasible, reproducible, and effective alternative to an extended surgical aortic treatment. However, even though this double technique appears to be a highly valuable option for the future, it obviously needs further evaluation with defined indications and follow-up.

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