Kyobu Geka. The Japanese Journal Of Thoracic Surgery[JOURNAL]
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200 papers
[Mitral Valvuloplasty in a Patient with Left Inferior Vena Cava with Hemiazygos Continuation:Report of a Case].
Onishi Y, Sasahara A, Shibata K … +2 more , Nie M, Ohara K
Kyobu Geka · 2025 Oct · PMID 41253330
Congenital anomalies of the inferior vena cava have been reported more frequently with the development of computed tomography (CT). Here, we report a case of a 70-year-old woman who was diagnosed with heterotaxy syndrome...
Congenital anomalies of the inferior vena cava have been reported more frequently with the development of computed tomography (CT). Here, we report a case of a 70-year-old woman who was diagnosed with heterotaxy syndrome and was suitable for mitral valvuloplasty. The diagnosis was made based on the preoperative contrast-enhanced CT findings of the left inferior vena cava with hemiazygos continuation into the coronary sinus and absence of the hepatic segment of the right inferior vena cava. The patient successfully underwent mitral valvuloplasty under cardiac arrest and cardiopulmonary bypass with drainage from the right superior vena cava and left femoral vein. The patient had an uneventful postoperative course and was discharged on postoperative day 13. In conclusion, the accurate preoperative diagnosis of cardiac and vascular anatomy is essential for developing effective surgical strategies in cardiac procedures, especially when a cardiopulmonary bypass is required.
[Minimally Invasive Aortic Valve Replacement for Quadricuspid Aortic Valve:Report of a Case].
Toyoda M, Fujioka S, Nie M … +2 more , Ohara K, Sakaki K
Kyobu Geka · 2025 Oct · PMID 41253329
A 80-year-old man presented to our hospital complaining exertional dyspnea. He was diagnosed with combined aortic valve regurgitation and stenosis due to quadricuspid aortic valve. The patient had no other cardiovascular...
A 80-year-old man presented to our hospital complaining exertional dyspnea. He was diagnosed with combined aortic valve regurgitation and stenosis due to quadricuspid aortic valve. The patient had no other cardiovascular anomaly. We performed aortic valve replacement( AVR) using minimally invasive cardiac surgery( MICS) approach. Four cusps were equal in size. Postoperative course was uneventful. AVR using MICS approach for quadricuspid aortic valve is extremely rare. In endoscopic surgery, the anatomical features of quadricuspid aortic valve can be more precisely understood, which may help in avoiding complications such as damage to the coronary ostia or the conduction system.
[Complicated with Spinal Cord Injury After Frozen Elephant Trunk Procedure for Stanford Type A Acute Aortic Dissection].
Midorikawa H, Ueno K, Takinami G … +4 more , Niitsuma K, Hotta A, Kanno M, Takano T
Kyobu Geka · 2025 Oct · PMID 41253328
We report two cases complicated with spinal cord injury after the frozen elephant trunk procedure for Stanford type A acute aortic dissection. The two patients experienced dissection from the ascending aorta to the iliac...
We report two cases complicated with spinal cord injury after the frozen elephant trunk procedure for Stanford type A acute aortic dissection. The two patients experienced dissection from the ascending aorta to the iliac arteries, and posterior false lumens were seen from Th8 to L2 in both cases. After an emergent surgery, both patients showed paraplegia and underwent immediate spinal fluid drainage. Symptoms improved to paraparesis in both patients, who were subsequently transferred to rehabilitation hospital. If a posterior false lumen is present from Th8 to L2, an increased risk of complications by spinal cord injury following the frozen elephant trunk procedure should be considered.
[Marfan Syndrome After Undergoing Genetic Testing Related to the Aorta, Following a Staged Total Aortic Replacement].
Kogure K, Nunokawa M, Inaba Y … +7 more , Takahashi Y, Ikezoe T, Minegishi S, Isaji T, Endo H, Hosoi Y, Kubota H
Kyobu Geka · 2025 Oct · PMID 41253327
A 59-year-old woman with a history of aortic dissection that began during pregnancy at the age of 34, which affected the aorta and its branches, underwent multiple surgeries, including aortic root replacement with a mech...
A 59-year-old woman with a history of aortic dissection that began during pregnancy at the age of 34, which affected the aorta and its branches, underwent multiple surgeries, including aortic root replacement with a mechanical valve, staged total aortic replacement extending to the bilateral iliac arteries, coil embolization of a left internal thoracic artery aneurysm, and bypass surgeries from the brachiocephalic artery to the right common carotid artery and right axillary artery, as well as from the left subclavian artery to the left axillary artery. Following these procedures, genetic testing was performed, leading to a diagnosis of Marfan syndrome. Genetic test identified the mutation c.2677+5 G>A in exon 21 of the FBN1 gene (variant:NM_000138.5). Even if the family history and phenotype do not meet the diagnostic criteria, genetic testing for aortic-related genes can play a supplementary role, leading to early and proactive antihypertensive treatment or surgical interventions to prevent events such as dissection or rupture.
[Giant Mediastinal Mature Teratoma Treated by Thoracoscopic Surgery with a Lateral Mini-thoracotomy].
Sakaguchi T, Matsumoto I, Takayama Y … +4 more , Nishikawa S, Wada T, Saito D, Kakegawa S
Kyobu Geka · 2025 Oct · PMID 41253326
Mediastinal teratomas are germ cell tumors that account for 15% of all adult anterior mediastinal tumors. Giant anterior mediastinal tumors sometimes require a median sternotomy and an additional approach or a clamshell...
Mediastinal teratomas are germ cell tumors that account for 15% of all adult anterior mediastinal tumors. Giant anterior mediastinal tumors sometimes require a median sternotomy and an additional approach or a clamshell approach. We present a case of a large mature teratoma occupying the left thoracic cavity that was treated by a thoracoscopic surgery with a lateral mini-thoracotomy. Preoperatively, we marked the lateral thoracic area near the largest cyst. In the right lateral recumbent position, a 4-cm incision was made in the left 6th intercostal space. Several large cysts were drained as much as possible. In the supine position, three 5-mm ports were placed in the 2nd, 5th, and 6th intercostal spaces. The left lobe of the thymus and the tumor were resected en block. Pathologically, the tumor was a mature teratoma. The patient had a good postoperative course and was discharged on the 8th postoperative day.
[Reformation of Working Style in Thoracic Surgery Department].
Soejima K, Matsuoka H
Kyobu Geka · 2025 Oct · PMID 41253325
BACKGROUND: In April 2024, we aimed to reform the physicians' working style in our hospital, which is a core regional hospital where only two full-time thoracic surgeons work. We report three efforts to enhance productiv...
BACKGROUND: In April 2024, we aimed to reform the physicians' working style in our hospital, which is a core regional hospital where only two full-time thoracic surgeons work. We report three efforts to enhance productivity despite of limited number of staff in the department of thoracic surgery. Efforts:1)A new on-call system for thoracic surgery was introduced in April, 2024. To reduce the burden of on-call, we designated certain days when the on-call service is unavailable, where as the minimum level of medical care is ensured by transporting patients to other hospitals on those days. 2)The postoperative critical pathway and task shifting are promoted in collaboration with nurses. Task shifting is implemented by enhancing co-medical education to reduce work and establish a safe system for early discharge. 3)A critical pathway for the outpatient follow-up system is being promoted. We built up an outpatient follow-up system with collaborating medical clinics and hospitals. The application rate of the system was 73.1%, indicating that reduces the burden of outpatient work and promotes functional differentiation. CONCLUSION: Establishing a sustainable medical system in collaboration with other departments, local medical institutions and residents is crucial in enhancing productivity with limited staff in the thoracic surgery department.
[Hemolytic Anemia due to an Inverted Felt Strip on Anastomosis in the Ascending Aorta for Acute Aortic Dissection].
Nishi T, Teramoto C, Yamazaki T
Kyobu Geka · 2025 Oct · PMID 41253324
During surgery for acute aortic dissection, reinforcing anastomoses in the aorta with felt strips is helpful for hemostasis. We had two cases of hemolytic anemia that developed due to inversion of an inner felt strip tha...
During surgery for acute aortic dissection, reinforcing anastomoses in the aorta with felt strips is helpful for hemostasis. We had two cases of hemolytic anemia that developed due to inversion of an inner felt strip that was applied at the proximal anastomosis in the ascending aorta. A 78-year-old woman underwent ascending aorta replacement for type A aortic dissection, and over the next 2.5 years, she gradually developed hemolytic anemia and underwent reoperation. A 47-year-old woman also had to undergo reoperation due to hemolytic anemia 17 days after ascending aorta replacement for type A aortic dissection. Based on these experiences, we make suture line in the felt much more proximal, and no further cases of hemolytic anemia have occurred since then.
[Coronary Artery Bypass Grafting Using a Left Internal Thoracic Artery Harvested by the "Bony Pedicled Method"].
Morishima Y, Koizumi K, Arakaki K … +1 more , Kuniyoshi Y
Kyobu Geka · 2025 Oct · PMID 41253323
A detailed report how to dissect an internal thoracic artery (ITA) from severe adhesion of thoracic bone tissue is not seen. We herein report the "bony pedicled method" as a novel technique for harvesting ITA graft in di...
A detailed report how to dissect an internal thoracic artery (ITA) from severe adhesion of thoracic bone tissue is not seen. We herein report the "bony pedicled method" as a novel technique for harvesting ITA graft in difficult case, such as severe adhesion to the costosternal portion. Case 1 was a 70-yearold man who had three-vessel-disease (3VD). Case 2 was a 69-year-old man who had unstable angina pectoris( UAP) due to severe 3VD. Case 3 was a 68-year-old man who had UAP due to left main trunk and double-vessel-disease. We planned coronary artery bypass grafting (CABG) using a left internal thoracic artery( LITA) grafts in these 3 cases. In their operative findings, LITAs had severe adhesion to the costosternal portions, so we dissected these portions using the "bony pedicled method" to avoid injury to the LITA grafts. We harvested the LITA grafts without any complications and performed their CABG as preoperative planning. Their postoperative courses were uneventful. All bypasses, including the LITA-left anterior descending artery( LAD) bypass in the 3 cases were patent on postop912 Vol.78 No.11(2025-10) erative three dimensional computed tomography( 3D-CT). The "bony pedicled method" is an appropriate method for harvesting ITA graft without injury in case which graft harvesting is difficult due to adhesion to the costosternal portion.
[Pulmonary Wedge Resection for a Dental Instrument Retained in the Bronchus for a Long Time Period:Report of a Case].
Iwanaga K, Soma Y, Miura K … +4 more , Taida S, Horiguchi J, Okamoto T, Uchino K
Kyobu Geka · 2025 Nov · PMID 41253322
It is often difficult to remove long-standing foreign bodies by bronchoscopy. The patient was a 57-year-old woman who accidentally aspirated a dental instrument during dental treatment. Two years later, an abnormal shado...
It is often difficult to remove long-standing foreign bodies by bronchoscopy. The patient was a 57-year-old woman who accidentally aspirated a dental instrument during dental treatment. Two years later, an abnormal shadow was noted on chest imaging, and she was referred to our hospital. Chest computed tomography (CT) revealed a 2-cm foreign body in the left lower lobe. Bronchoscopy was performed, but the foreign body could not be removed. Thoracoscopic partial resection of the left lower lobe was undertaken for removal of the foreign body.
[Invasive Thymoma with Unexpected Pleural Dissemination Completely Resected Under 4K Three-dimensional Endoscopy:Report of a Case].
Kamada Y, Ishida M, Kagimoto A … +4 more , Kajiwara K, Yamamoto R, Kuraoka K, Mimura T
Kyobu Geka · 2025 Nov · PMID 41253321
According to the guidelines for thymic tumors, surgical resection is recommended for clinical stage Ⅳ thymic epithelial tumors if completely resectable. A 38-year-old woman presented with fever, chest pain, and back pain...
According to the guidelines for thymic tumors, surgical resection is recommended for clinical stage Ⅳ thymic epithelial tumors if completely resectable. A 38-year-old woman presented with fever, chest pain, and back pain. Computed tomography (CT) revealed a mediastinal tumor, which was diagnosed as thymoma type B3 through CT-guided biopsy. Intraoperatively, using 4K three-dimensional (3D) endoscopy, tumor invasion into the left upper lobe and pleural dissemination on the parietal pleura and diaphragm were observed. To preserve the possibility of future re-resection, operation was thoracoscopically performed and the tumor was removed, including partial resection of the left upper lobe. All visible pleural dissemination lesions were also resected, including part of the left diaphragm. The diaphragmatic defect was reconstructed using a Gore-Tex Patch. There is no established treatment strategy for thymoma with incidental pleural dissemination, and the 4K 3D endoscopy may contribute to the successful completion of such a complex operation.
[Pleural Dissemination of Papillary Thyroid Carcinoma:Report of a Case].
Nishikawa T, Inoue T, Inoue T … +7 more , Nagahisa S, Kuyama Y, Takahashi M, Mori M, Matsuura M, Kamikawa Y, Inoue F
Kyobu Geka · 2025 Nov · PMID 41253320
A 67-year-old man was performed total thyroidectomy for stage ⅣC papillary thyroid carcinoma with multiple lymph node and lung metastases. Five years and two months later, treatment with lenvatinib was started. Chest com...
A 67-year-old man was performed total thyroidectomy for stage ⅣC papillary thyroid carcinoma with multiple lymph node and lung metastases. Five years and two months later, treatment with lenvatinib was started. Chest computed tomography (CT) six years and four months after the start of treatment revealed left pleural effusion. A pleural biopsy was performed under thoracoscopy. Histopathological findings showed papillary thyroid carcinoma, and the patient was diagnosed with pleural dissemination of thyroid cancer. Genetic test showed a positive BRAF V600E gene mutation. Treatment with dabrafenib and trametinib was initiated nine days after lenvatinib was discontinued.
[Emergency Pulmonary Embolectomy with Combined Use of Retrograde Pulmonary Perfusion for Massive Pulmonary Thromboembolism:Report of a Case].
Hara H, Haijima N, Shimizu H … +2 more , Kudou M, Shimizu H
Kyobu Geka · 2025 Nov · PMID 41253319
Massive pulmonary embolism is a life-threatening disease, which requires early intensive care. Surgical pulmonary embolectomy is a last resort for patients with hemodynamic instability. We report the case of an emergency...
Massive pulmonary embolism is a life-threatening disease, which requires early intensive care. Surgical pulmonary embolectomy is a last resort for patients with hemodynamic instability. We report the case of an emergency pulmonary embolectomy with using retrograde pulmonary perfusion (RPP) for massive pulmonary thromboembolism. The patient is a 54-year-old male who was admitted to neurosurgical department for brain infarction. Due to his immobility, he developed deep vein thrombosis in the right superficial femoral vein and then, suddenly collapsed with chest pain. While we prepared for introduction of extracorporeal membrane oxygenation, he was resuscitated and diagnosed with massive pulmonary embolism on pulmonary arterial angiography. Emergency pulmonary embolectomy with using RPP was successfully performed. Postoperative course is uneventful except that he had percutaneous tracheostomy in postoperative day 11. We did not detect residual clots in bilateral pulmonary arteries. After 73 days of hospitalization, he was discharged from hospital. As this novel surgical approach has been rarely reported in Japan, we reviewed all three cases from Japan.
[Experience of Neuroleptic Malignant Syndrome After Operation:Total Arch Replacement for Stanford Type A Acute Aortic Dissection:Report of a Case].
Nosaka Y, Ikeda M
Kyobu Geka · 2025 Nov · PMID 41253318
A 50-year-old woman underwent total arch replacement for Stanford type A acute aortic dissection. Postoperatively, she became delirious and experienced difficulty maintaining rest, so haloperidol was used. Due to persist...
A 50-year-old woman underwent total arch replacement for Stanford type A acute aortic dissection. Postoperatively, she became delirious and experienced difficulty maintaining rest, so haloperidol was used. Due to persistent high fever and markedly elevated serum levels of creatinine kinase, neuroleptic malignant syndrome was suspected. We discontinued haloperidol and started dantrolene. During the same period, we ruled out infections, central nervous system disorders, and organ ischemia due to dissection. Administration of dantrolene achieved a good outcome, with reduction of fever and improvement of creatinine kinase levels. Neuroleptic malignant syndrome after aortic dissection surgery is very rare and includes numerous differential diagnoses. However, prompt action is important because delays in diagnosis and treatment can lead to deterioration in the general condition of the patient.
[Aortic Root Reconstruction Using Partial Remodeling Technique for Stanford Type A Acute Aortic Dissection:Report of a Case].
Yamada H, Onuki Y, Kamikawa Y … +1 more , Shimada N
Kyobu Geka · 2025 Nov · PMID 41253317
We report a case of Stanford type A acute aortic dissection successfully treated with partial remodeling (PR) technique for aortic root reconstruction. A 60-year-old male presented with chest pain and was diagnosed as ha...
We report a case of Stanford type A acute aortic dissection successfully treated with partial remodeling (PR) technique for aortic root reconstruction. A 60-year-old male presented with chest pain and was diagnosed as having acute aortic dissection with pericardial effusion. Emergency surgery revealed intimal tear in the right coronary sinus. We performed PR technique, reconstructing only the right coronary sinus with a prosthetic patch while preserving the native aortic valve. The patient recovered well and postoperative computed tomography (CT) showed patent reconstructed right coronary artery. PR technique, when appropriately indicated, offers advantages of shorter operative time with native valve preservation, making it a valuable option for selected cases of acute aortic dissection involving the aortic root.
[Pseudoaneurysm at the Brachiocephalic Artery Anastomosis After Acute Aortic Dissection Surgery Treated with Endovascular Stent Grafting:Report of a Case].
Kuroo K, Iida Y, Inaba Y … +2 more , Hachiya T, Shimizu H
Kyobu Geka · 2025 Nov · PMID 41253316
We report a case of endovascular stent grafting for a pseudoaneurysm at the brachiocephalic artery anastomosis after acute aortic dissection surgery. A 48-year-old male underwent total arch replacement for Stanford type...
We report a case of endovascular stent grafting for a pseudoaneurysm at the brachiocephalic artery anastomosis after acute aortic dissection surgery. A 48-year-old male underwent total arch replacement for Stanford type A acute aortic dissection. One month postoperatively, thoracic endovascular aortic repair (TEVAR) was performed to treat true lumen narrowing due to residual dissection. Two months after the initial surgery, he was emergently admitted with anterior chest pain. Close examination revealed a pseudoaneurysm at the brachiocephalic artery anastomosis, forming a mediastinal hematoma. Endovascular stent grafting was performed after creating a right axillary artery-to-right common carotid artery bypass. The stent graft successfully covered the pseudoaneurysm and the dissected segment of the right common carotid artery. The patient had no neurological complications, and postoperative contrast-enhanced computed tomography (CT) confirmed patency of the bypass and exclusion of the pseudoaneurysm. Endovascular stent grafting is a minimally invasive and effective treatment, achieving both pseudoaneurysm exclusion and entry closure.
[Cardiac Cavernous Hemangioma in the Right Atrium:Report of a Case].
Sakamoto S, Saito S, Akutsu H … +3 more , Kawata H, Fukushima N, Kawahito K
Kyobu Geka · 2025 Nov · PMID 41253315
Cardiac hemangioma is a rare benign tumor, and the cavernous type accounts for 50~60% of all cardiac hemangiomas. Although most cases are asymptomatic, the risk of serious complications, such as embolism, arrhythmia, tum...
Cardiac hemangioma is a rare benign tumor, and the cavernous type accounts for 50~60% of all cardiac hemangiomas. Although most cases are asymptomatic, the risk of serious complications, such as embolism, arrhythmia, tumor rupture, coronary artery obstruction, or sudden death, is high, and surgical resection should be considered. In a 60-year-old woman, follow-up imaging studies after a left breast cancer operation incidentally revealed a cardiac tumor in the right atrium. Transthoracic echocardiography showed a poorly mobile, highly echogenic 12×16 mm mass with clear margins, and contrast-enhanced computed tomography (CT) showed a round tumor with no obvious enhancement. The tumor was resected with an atrial wall and diagnosed as a cavernous hemangioma on histopathological examination. Cardiac hemangiomas are enhanced using contrast medium; however, some cases have no contrast enhancement. Histopathological examination confirmed this diagnosis. The patient was discharged on postoperative day 11 in a good condition.
[Aortic Valve Replacement for Active Infective Endocarditis with Multiple Cerebral Infarctions and Subarachnoid Hemorrhage:Report of a Case].
Ogawa T, Maeda M, Otani S … +1 more , Yamamoto T
Kyobu Geka · 2025 Nov · PMID 41253314
We report a case of successful surgical treatment of infected aortic valve endocarditis with intractable heart failure, multiple cerebral infarction, and subarachnoid hemorrhage. A 46-year-old man who had fever for two w...
We report a case of successful surgical treatment of infected aortic valve endocarditis with intractable heart failure, multiple cerebral infarction, and subarachnoid hemorrhage. A 46-year-old man who had fever for two weeks and subsequent left hemiplegia was admitted to our hospital. Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed multiple cerebral infarction and subarachnoid hemorrhage. Echocardiography showed severe aortic regurgitation with a huge mobile vegetation. Despite medical treatment, chest X-ray revealed progressive pulmonary congestion. We performed aortic valve replacement three days after admission. Cerebral hematoma got slightly larger, but neurological symptom did not worsen. Postoperative course was uneventful. Perioperative antibiotic administration was continued and he was discharged on the postoperative day 46.
[Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva Treated with Modified Unroofing Procedure].
Sakai K, Okumura Y, Yoshida T
Kyobu Geka · 2025 Nov · PMID 41253313
We report a case of a 50-year-old man with anomalous aortic origin of the right coronary artery (AAORCA) and hypertrophic obstructive cardiomyopathy (HOCM), who was treated with modified unroofing and septal myectomy. Th...
We report a case of a 50-year-old man with anomalous aortic origin of the right coronary artery (AAORCA) and hypertrophic obstructive cardiomyopathy (HOCM), who was treated with modified unroofing and septal myectomy. The patient presented with exertional syncope. Echocardiography revealed systolic anterior motion (SAM)-associated severe mitral regurgitation (MR) and HOCM. Coronary computed tomography (CT) showed AAORCA with an inter-arterial course and occlusion of the left anterior descending artery (LAD). Intraoperative findings confirmed intramural segment of the anomalous coronary artery was near the commissure of the aortic valve. To preserve native aortic valve function, modified unroofing technique was employed to establish a new right coronary ostium. Septal myectomy was performed to relieve left ventricular outflow tract obstruction, and coronary artery bypass grafting using the left internal thoracic artery was conducted to revascularize the LAD. Postoperatively, myocardial ischemia was resolved, and MR disappeared. The patient was discharged on postoperative day 10 without complications and has remained free of syncope during three years of follow-up.
[Giant Mediastinal Liposarcoma Resected via Clamshell Thoracotomy Combined with Lower Partial Sternotomy].
Tani K, Kimura D, Matsuo T … +6 more , Sasaki T, Yamaguchidani T, Kimura S, Ichinohe C, Kato T, Minakawa M
Kyobu Geka · 2025 Nov · PMID 41253312
A 74-year-old male was admitted with acute cholecystitis, during which computed tomography( CT) revealed a 20 cm anterior mediastinal tumor. He developed septic shock requiring tracheostomy and mechanical ventilation, an...
A 74-year-old male was admitted with acute cholecystitis, during which computed tomography( CT) revealed a 20 cm anterior mediastinal tumor. He developed septic shock requiring tracheostomy and mechanical ventilation, and was referred to our institution. Biopsy under local anesthesia excluded malignant lymphoma and germ cell tumor, leading to planned surgical resection. Due to the tumor's extensive bilateral spread and proximity to the tracheostomy site, clamshell thoracotomy with lower partial sternotomy was performed instead of median full sternotomy. The final diagnosis was well-differentiated liposarcoma. The sternum was closed with wires and plates, and prophylactic negative pressure wound therapy was applied. Postoperatively, there were no sternal complications. Laparoscopic cholecystectomy was later performed, and the tracheostomy cannula was removed successfully. In surgical resection of giant mediastinal tumors, the approach should be selected based on the tumor's location and its extent of invasion into surrounding tissues.
[Thoracic Endovascular Aortic Repair for Intra-aortic Thrombosis in the Distal Arch].
Saiki M, Yunoki K, Inoue T … +7 more , Higashi K, Narumiya Y, Morita S, Toya T, Tamura K, Tateishi A, Hisamochi K
Kyobu Geka · 2025 Nov · PMID 41253311
An 81-year-old woman was referred to our hospital due to anorexia and low-grade fever for the past two weeks, and was urgently hospitalized since a computed tomography (CT) scan revealed a thrombus in the greater curvatu...
An 81-year-old woman was referred to our hospital due to anorexia and low-grade fever for the past two weeks, and was urgently hospitalized since a computed tomography (CT) scan revealed a thrombus in the greater curvature of the distal aortic arch and proximal descending aorta. However, because of her fraility and poor general condition, surgery was not indicated at the time of admission, and anticoagulation therapy was initiated awaiting recovery of her condition. Considering the patient's age and comorbidities, thoracic endovascular aortic repair (TEVAR) was selected after thorough consultation with the family. In this case, because the device had to be passed through the lesser curvature of the aortic arch to prevent thromboembolisms, the left fifth intercostal space was opened and a tug of wire was established between the apex of the heart and the right groin. By using this technique, device deploy could be carried out without thromboembolisms. The patient was discharged from hospital without any perioperative embolic complications and is currently followed-up at the outpatient clinic.
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