Kyobu Geka. The Japanese Journal Of Thoracic Surgery[JOURNAL]
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200 papers
[Medical Diagnostic Imaging].
Inage T, Suzuki H
Kyobu Geka · 2025 Sep · PMID 40998336
Significant advancements in medical imaging technology have been made over the years. Currently, several commercial post-processing software solutions-such as Synapse Vinsent and Ziostation-are available to facilitate th...
Significant advancements in medical imaging technology have been made over the years. Currently, several commercial post-processing software solutions-such as Synapse Vinsent and Ziostation-are available to facilitate the creation of photorealistic three-dimensional (3D) images. Three-dimensional lung reconstruction with virtual modeling offers the opportunity to visualize tumors within the target segment or lobe and to confirm the bronchovascular anatomy, thereby enabling optimal surgical planning. Cross reality (XR)-which includes virtual reality (VR), augmented reality (AR), and mixed reality (MR)-enables surgeons to interact with computer-generated environments based on reality. In thoracic surgery, XR tools support anatomical assessment, surgical training through lifelike procedural simulations, preoperative planning, and intraoperative guidance. Lung perfusion scintigraphy with single photon emission computed tomography (SPECT-CT) allows for quantification of lobar perfusion during preoperative assessment of lung cancer candidates and provides a more accurate prediction of postoperative residual pulmonary function. Fractional flow reserve computed tomography (FFRCT) analysis is a non-invasive diagnostic tool used to determine the physiological impact of coronary artery disease (CAD) in patients with symptoms suggestive of CAD. The FFRCT has been demonstrated to reduce the necessity for invasive coronary angiography that shows no significant CAD. Coronary computed tomography angiography (CCTA) is a highly sensitive method of evaluating vascular anatomy, coronary plaque, calcification and stenosis. The pericoronary fat attenuation index (FAI), a new imaging biomarker derived from CCTA, assesses vascular inflammation by detecting respective gradients in coronary perivascular adipose tissue attenuation. Several studies have shown that elevated pericoronary FAI is associated with vascular inflammation and increased risk of cardiac events.
[Perspectives on Vital Sign Monitoring Systems in Perioperative Period of Thoracic Surgery].
Kawamoto S
Kyobu Geka · 2025 Sep · PMID 40998335
In this review article, the latest monitoring systems for vital signs in intensive care units (ICU), presenting illness-severity score, early warning score, are introduced. These systems combined with artificial intellig...
In this review article, the latest monitoring systems for vital signs in intensive care units (ICU), presenting illness-severity score, early warning score, are introduced. These systems combined with artificial intelligence might integrate into tele/remote-ICU system, and would provide evidence-based standardized perioperative care after cardiothoracic surgeries, and improve the outcomes of surgeries.
[Latest Innovations in Illumination and Engineering Equipment for Thoracic Surgery].
Takeyoshi D, Kamiya H
Kyobu Geka · 2025 Sep · PMID 40998334
In thoracic surgery, where precision and safety are paramount, advanced lighting and optical technologies play a critical role in enhancing surgical outcomes. Recent developments in lighting systems have improved brightn...
In thoracic surgery, where precision and safety are paramount, advanced lighting and optical technologies play a critical role in enhancing surgical outcomes. Recent developments in lighting systems have improved brightness, reduced heat generation, and enabled more accurate color rendering, supporting safer and more efficient procedures. The shift toward minimally invasive techniques, such as thoracoscopic and robot-assisted surgeries, has further accelerated the need for high-quality visualization tools. Three-dimensional (3D) imaging, high-resolution displays, and fluorescence-guided visualization now allow for better identification of anatomical structures. Furthermore, augmented reality (AR) and artificial intelligence (AI) are being integrated into surgical practice. Preoperative imaging data can be reconstructed in 3D and overlaid during surgery to enhance accuracy in tumor localization and vascular mapping. Wearable optical devices and digital operating room systems are also improving communication and collaboration among surgical teams, allowing for real-time sharing of visual information and remote guidance. These technologies are increasingly contributing not only to surgical precision but also to team-based workflows, education, and training. Looking ahead, real-time AI-AR fusion systems and remote navigation support may further transform thoracic surgery by enabling safer, more informed decision-making in complex procedures.
[Respirator in New Technology for Respiratory Medicine].
Matsuda Y
Kyobu Geka · 2025 Sep · PMID 40998333
According to the progress in medical devices, respirators are improving to avoid ventilator-associated lung injury with new technology and concepts. At first, we need to know the methods of respirator settings; they are...
According to the progress in medical devices, respirators are improving to avoid ventilator-associated lung injury with new technology and concepts. At first, we need to know the methods of respirator settings; they are the respiratory mode and method. Respiratory modes are assist/control (A/C), synchronized intermittent mandatory ventilation (SIMV), and continuous positive airway pressure (CPAP). The respiratory methods are volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV), and pressure support ventilation (PSV). The new methods of ventilation are airway pressure release ventilation (APRV) and neurally adjusted ventilatory assist (NAVA). To protect the lung injury by ventilation, we need to control the limitation of ventilation volume in one breath, high positive end-expiratory pressure, plateau pressure in lung alveoli, auto positive end-expiratory pressure, and driving pressure in respiration. Coming to the new devices, lung injury would be mitigated by mechanical ventilation.
[Extracorporeal Membrane Oxygenation( ECMO) as an Emerging Technology:Present and Future].
Anraku M
Kyobu Geka · 2025 Sep · PMID 40998332
Extracorporeal membrane oxygenation (ECMO) has become an essential therapeutic modality for severe respiratory and circulatory failure. Recent technological advances have lowered the operational threshold for ECMO by ena...
Extracorporeal membrane oxygenation (ECMO) has become an essential therapeutic modality for severe respiratory and circulatory failure. Recent technological advances have lowered the operational threshold for ECMO by enabling safer, more portable, and user-friendly systems. This article reviews the latest developments in ECMO-related technologies from the perspective of practicing clinicians. Key topics include the miniaturization and transportability of devices, improvements in centrifugal pumps and membrane lungs, and the incorporation of real-time monitoring and automatic control. Surface coatings using phosphorylcholine or hydrophilic polymers have enhanced biocompatibility and extended device longevity. Artificial intelligence and deep learning are being explored to assist in real-time decision-making and survival prediction. Furthermore, the potential for long-term implantable oxygenators is gaining attention. Our group has demonstrated prolonged in vivo function of a novel silicone membrane lung with methacryloyloxyethyl phosphorylcholine (MPC) polymer coating in large animal models, achieving thrombosis-free support for up to 100 days. The early conceptual framework for an implantable intrathoracic artificial lung, proposed by Mortensen in 1994, is gradually becoming technically feasible thanks to material and design innovations. These multifaceted advancements promise to broaden the future clinical applications of ECMO and improve outcomes across both acute and chronic indications.
[Advancements in Anesthesia and Anesthesia-related Technologies].
Imai Y
Kyobu Geka · 2025 Sep · PMID 40998331
In thoracic surgery, general anesthesia remains the standard approach. During the procedure, one-lung ventilation using double-lumen tubes or bronchial blockers is employed as needed. For postoperative pain control, a mu...
In thoracic surgery, general anesthesia remains the standard approach. During the procedure, one-lung ventilation using double-lumen tubes or bronchial blockers is employed as needed. For postoperative pain control, a multimodal approach is taken, incorporating options such as thoracic epidural anesthesia, paravertebral blocks, intercostal nerve blocks, and intravenous patient-controlled analgesia (IV-PCA). These practices have remained consistent in recent years. However, anesthetics and anesthesia-related devices including physiological monitors and ultrasound machines have continued to evolve. As a result, anesthesia today differs significantly from that of a decade ago. This section highlights the latest advances in anesthetics and anesthesia-related technologies, including: (1) the use of artificial intelligence (AI) for monitoring and decision support, (2) robotic anesthesia systems with automated drug delivery, (3) remimazolam as a novel ultra-short-acting sedative, and (4) autologous blood recovery systems capable of platelet collection, improving hemostasis and reducing transfusion requirements. Although the clinical efficacy of these innovations remains to be established through future research, there is considerable anticipation surrounding their potential to enhance the quality of anesthesia management.
[Thymic Lymphoepithelial Carcinoma:Report of a Case].
Miura K, Kawabata N, Iwanaga K
Kyobu Geka · 2025 Aug · PMID 40840890
Thymic lymphoepithelial carcinoma (LEC) is a rare subtype of thymic cancer and reported in 6% of thymic carcinoma. In terms of histopathology, it closely mimics undifferentiated tumors that originate in the nasopharynx,...
Thymic lymphoepithelial carcinoma (LEC) is a rare subtype of thymic cancer and reported in 6% of thymic carcinoma. In terms of histopathology, it closely mimics undifferentiated tumors that originate in the nasopharynx, and in half of the cases, it has been associated to the Epstein-Barr (EB) virus infection. Seven reports have been published on the result of surgical resection, particularly in the early stages of thymic LEC. Recurrence was reported in three patients, and one patient died. In our case, the patient underwent video-assisted thoracoscopic surgery for a partial thymectomy and thymomectomy and was alive without recurrence 92 months after the surgery without adjuvant therapy.
[Thymoma with Extensive Necrosis:Report of a Case].
Shinoda M, Suzuki H, Shomura S … +1 more , Inoue K
Kyobu Geka · 2025 Aug · PMID 40840889
A 65-years-old female was admitted to our hospital for treatment of fever and chest pain. Contrast-enhanced computed tomography (CT) revealed an anterior mediastinal tumor with a thickened wall, and right pleural effusio...
A 65-years-old female was admitted to our hospital for treatment of fever and chest pain. Contrast-enhanced computed tomography (CT) revealed an anterior mediastinal tumor with a thickened wall, and right pleural effusion. Ten days after antibiotic therapy, the fever, chest pain and pleural effusion disappeared. Thymectomy was performed to confirm the diagnosis. Histopathologic diagnosis was type B2 thymoma with extensive necrotic area, Masaoka's stageⅠ. No recurrence has been observed for approximately two years since the surgery. Thymomas have a variety of pathological features such as cystic and hemorrhagic changes and necrosis. However, thymomas with extensive necrosis are very rare. We presented this case with a review of the literature.
[Primary Lung Cancer that Developed Lung Abscess after Bronchoscopy and Was Cured by Surgery:Report of a Case].
Kimura K, Itou N, Yoshimura M … +1 more , Kuza I
Kyobu Geka · 2025 Aug · PMID 40840888
The patient was a 72-year-old man. Chest computed tomography (CT) scan revealed a mass in the right lower lobe, so he underwent bronchoscopy. The pathological findings revealed squamous cell carcinoma. He was discharged...
The patient was a 72-year-old man. Chest computed tomography (CT) scan revealed a mass in the right lower lobe, so he underwent bronchoscopy. The pathological findings revealed squamous cell carcinoma. He was discharged the day after the examination, but was admitted to the hospital seven days later for fever. Chest CT scan showed a lung abscess at the site of the mass in the right lower lobe, so he was admitted to the hospital on an emergency basis. After admission, treatment with tazobactam and piperacin 13.5 g/day was started, but there was little improvement, so the decision was made to perform surgery, and a right lower lobectomy was performed via thoracotomy five days after the admission. The postoperative course was uneventful, and the patient was discharged on the 19th day after surgery. As the surgery was immediately performed after confirming that antimicrobial agents were ineffective, the patient was cured without any complications.
[Abdominal Aortic Bifurcation Occlusion Caused by a Left Atrial Myxoma:Report of a Case].
Sasahara A, Onishi Y, Shibata K … +2 more , Nie M, Ohara K
Kyobu Geka · 2025 Aug · PMID 40840887
A 30-year-old male patient who reported a medical history of bronchial asthma and diabetes mellitus presented with bilateral leg pain and weakness during exercise. He experienced leg numbness for the previous six months....
A 30-year-old male patient who reported a medical history of bronchial asthma and diabetes mellitus presented with bilateral leg pain and weakness during exercise. He experienced leg numbness for the previous six months. Imaging detected a thromboembolic occlusion in the abdominal aorta, along with a left atrial mass. He underwent an emergency embolectomy with a Fogarty balloon catheter;however, persistent embolism at the aortic bifurcation required surgical embolus removal. The embolus consisted of both fresh thrombus and mucous-like tumor tissue, which was determined as a myxoma. Further left atrial mass assessment indicated a myxoma. After successful revascularization and left atrial mass removal, the patient recovered without complications, and he was discharged home 24 days after rehabilitation.
[Delayed Cardiac Partial Herniation after Right-sided Pneumonectomy:Report of a Case].
Sakaguchi T, Hirayama R, Matsukawa M … +5 more , Uekihara K, Urashita S, Miyamoto T, Kojima T, Suzuki R
Kyobu Geka · 2025 Aug · PMID 40840886
Cardiac herniation is a rare complication after pulmonary surgery. A 59-year-old woman underwent right-sided pneumonectomy for right pulmonary squamous cell carcinoma, pulmonary vein was ligated intrapericardialy and the...
Cardiac herniation is a rare complication after pulmonary surgery. A 59-year-old woman underwent right-sided pneumonectomy for right pulmonary squamous cell carcinoma, pulmonary vein was ligated intrapericardialy and the pericardial defect, which mesasured about 2 cm was not repaired. After four months, the patient complained of bilateral lower leg edema and dyspnea on effort. Computed tomography (CT) showed the right atrial herniation into the right-sided thoracic cavity. We diagnosed with symptomatic cardiac herniation and performed opration with small thoracotomy. At operation it was found that the right atrium herniated into the right-sided thoracic cavity. There were no adhesions between the pericardium and the right atrium. We placed the right atrium back within the pericardium and repaired using a bovine pericardial patch. The postoperative course was uneventful. Bilateral lower leg edema and cardiac herniation disappeared. Cardiac herniation did not recur over four years postoperatively.
[Thoracic Aortic Stent-graft Treatment for Pseudoaneurysm in Advanced Esophageal Cancer:Report of Two Cases].
Tanaka Y, Kusakizako M, Nakagawa T … +5 more , Yokawa K, Higuma T, Yoshida K, Obo H, Wakiyama H
Kyobu Geka · 2025 Aug · PMID 40840885
Aortic pseudoaneurysm is a rare complication of advanced esophageal cancer. While emergency open aortic surgery is associated with high operative mortality, massive bleeding without treatment is fatal. On the other hand,...
Aortic pseudoaneurysm is a rare complication of advanced esophageal cancer. While emergency open aortic surgery is associated with high operative mortality, massive bleeding without treatment is fatal. On the other hand, thoracic endovascular aortic repair (TEVAR) for pseudoaneurysm is far less invasive. We experienced two cases of aortic pseudoaneurysm successfully treated by TEVAR. Case 1:68-year-old male. During preoperative adjuvant chemotherapy for advanced esophageal cancer, he was diagnosed with esophageal non-aortic fistula by computed tomography (CT). Case 2:80-year-old woman. She complained dysphagia, and CT revealed an aortic pseudoaneurysm associated with mediastinal perforation of advanced esophageal cancer and direct invasion to the descending aorta. Considering their general condition, they underwent minimally invasive TEVAR. Clinical condition dramatically improved and they become able to eat well, and they were transferred to the hospice until they died of cachexia due to progression of esophageal cancer.
[Endovascular Treatment for Stanford Type B Aortic Dissection with Recurrent Malperfusion Three Months after Thoracic Endovascular Aortic Repair:Report of a Case].
Kataoka G, Ito F, Watanabe M
Kyobu Geka · 2025 Aug · PMID 40840884
We report a case of a 49-year-old man with distal stent-graft-induced new entry (d-SINE) three months after first thoracic endovascular aortic repair( TEVAR) for acute complicated type B aortic dissection (acTBAD). The d...
We report a case of a 49-year-old man with distal stent-graft-induced new entry (d-SINE) three months after first thoracic endovascular aortic repair( TEVAR) for acute complicated type B aortic dissection (acTBAD). The d-SINE led to acTBAD recurrence of acTBAD, resulting in malperfusion of the lower limbs and kidneys. The d-SINE was observed in the aorta at the Th8 level, and there was an obvious re-entry in the left common iliac artery( CIA). Additional TEVAR was performed using a modified extended provisional extension to induce complete attachment (e-PETTICOAT). Without balloon dilation, a straight stent graft (SG) was inserted into the aorta at the level of superior to the celiac trunk, then a bifurcated SG was placed from below the renal artery( RA) to the CIA, and finally a bare stent was inserted between them. The d-SINE and retry tears of the acTBAD were closed simultaneously. Despite extensive stent graft placement, we were able to improve the malperfusion of the lower limbs and kidneys and prevent aortic rupture without causing neurological complications. No SINE occurred, and good aortic remodeling was achieved from the left subclavian artery( LCA) to the CIA 14 months after the additional TEVAR.
[Frozen Elephant Trunk Technique with Semi-circumferential Aortic Arch Incision for Distal Arch Aortic Aneurism Rupture:Report of a Case].
Tokuda T, Yamada Y
Kyobu Geka · 2025 Aug · PMID 40840883
An 82-year-old man was admitted to our hospital with chest pain as a chief complaint and diagnosed with a ruptured aortic aneurysm in the distal arch by contrast-enhanced computed tomography (CT). The patient underwent s...
An 82-year-old man was admitted to our hospital with chest pain as a chief complaint and diagnosed with a ruptured aortic aneurysm in the distal arch by contrast-enhanced computed tomography (CT). The patient underwent surgery using artificial heart-lung and selective cerebral extracorporeal circulation, and a semi-circumferential aortic arch incision was made around the anterior surface of the aortic arch. An open stent graft was inserted through the incision, trimmed to fit the size, and the aortic wall and the stent graft were fixed with 3-0 proline continuous sutures, and finally the incision was closed with 3-0 proline. This method was useful because it may shorten the operation time and decrease the amount of blood loss compared to the common aortic arch replacement with frozen elephant trunk.
[Main Trunk Interposition for Adult Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Using a Great Saphenous Vein:Report of a Case].
Chen K, Masuda A, Mikoshiba H … +2 more , Iwakura T, Shimokawa T
Kyobu Geka · 2025 Aug · PMID 40840882
A 54-year-old woman was incidentally diagnosed with anomalous origin of the left coronary artery from the pulmonary artery( ALCAPA) during a pre-treatment screening computed tomography( CT) scan for alopecia areata. She...
A 54-year-old woman was incidentally diagnosed with anomalous origin of the left coronary artery from the pulmonary artery( ALCAPA) during a pre-treatment screening computed tomography( CT) scan for alopecia areata. She had no cardiac symptoms, but cardiac magnetic resonance imaging( MRI) revealed late gadolinium enhancement (LGE) in the mid-anterior wall of the left ventricle, indicating myocardial ischemia. Median sternotomy was performed, with the left main trunk (LMT) was transected from the main pulmonary artery. Initially, reconstruction with an expanded polytetrafluoroethylene(ePTFE) graft was attempted, but the fragility of the vessel wall led to a change in strategy. A saphenous vein graft( SVG) was interposed between the aorta and LMT. The defect in the pulmonary artery was reconstructed with a bovine pericardial patch. Postoperative progress was favorable. Coronary CT during the one-year follow-up confirmed patency of the SVG and suggested regression of collateral circulation, indicating improved perfusion through the newly established graft.
[Coronary Artery Bypass Graft Surgery in a Single Coronary Artery Originating from the Right Aortic Sinus:Report of a Case].
Sugiyama H, Yoshitani N, Ahn K … +2 more , Misato T, Hayashi T
Kyobu Geka · 2025 Aug · PMID 40840881
Coronary artery anomalies (CCAs) are a group of congenital conditions characterized by abnormal origin or course. Coronary artery bypass graft( CABG) surgery in this single coronary artery( SCA) is rarely reported. In th...
Coronary artery anomalies (CCAs) are a group of congenital conditions characterized by abnormal origin or course. Coronary artery bypass graft( CABG) surgery in this single coronary artery( SCA) is rarely reported. In this case, A 41-year-old male patient presented with exertional dyspnea and productive cough. The echocardiogram showed a moderately dilated left ventricular (LV) with mild LV systolic impairment and coronary angiography (CAG) revealed the left main coronary artery arises from the right coronary ostium with the right coronary artery. In addition, occlusion in right coronary mid-portion and distal circumflex and moderate to severe stenosis in proximal left anterior descending artery was identified. Considering the significant atherosclerosis and the subpulmonic course of this SCA, CABG with sequential anastomosis of saphenous vein was performed. Postoperatively, he made good progress and was discharged day 6 after surgery without any complication.
[Ventricular Septal Defect in an Elderly Patient:Report of a Case].
Tani K, Ueyama K, Sakakura R … +3 more , Sugiyama H, Fukuzawa M, Murakami A
Kyobu Geka · 2025 Aug · PMID 40840880
Ventricular septal defect (VSD) is one of the most common congenital heart diseases, but untreated cases reaching advanced age are rare. We report a case of an 85-year-old woman with an untreated VSD who presented with d...
Ventricular septal defect (VSD) is one of the most common congenital heart diseases, but untreated cases reaching advanced age are rare. We report a case of an 85-year-old woman with an untreated VSD who presented with dyspnea. Despite the relatively large defect (12×16 mm), she had no prior history of heart failure. Echocardiography and catheterization revealed a left-to-right shunt with mild pulmonary hypertension. Surgical closure was performed using a Dacron patch, and the patient had a favorable postoperative course. The absence of early heart failure was likely due to a hypertrophied trabecular muscle partially covering the defect, limiting the left-to-right shunt. However, as right ventricular hypertrophy progressed, the defect widened, leading to acute heart failure. This case highlights the potential for long-term survival in patients with specific anatomical modifications and underscores the importance of individualized surgical decision-making in elderly VSD patients.
[Leadless Pacemaker Implantation During Tricuspid Valve Surgery in the Presence of a Permanent Pacemaker with Tricuspid Regurgitation:Report of a Case].
Tokunaga K, Ueno T, Moriyama Y … +1 more , Yamamoto H
Kyobu Geka · 2025 Aug · PMID 40840879
A 74-year-old man was implanted with a permanent pacemaker for sick sinus syndrome ten years earlier and permanent atrial fibrillation( AF). Echocardiography indicated progressive severe tricuspid regurgitation (TR) and...
A 74-year-old man was implanted with a permanent pacemaker for sick sinus syndrome ten years earlier and permanent atrial fibrillation( AF). Echocardiography indicated progressive severe tricuspid regurgitation (TR) and right ventricular systolic dysfunction with tricuspid annular dilatation and tricuspid valve tethering. The pacemaker lead passing through the tricuspid valve may have contributed to TR, therefore we decided to perform tricuspid valve surgery, pacemaker lead removal, and leadless pacemaker implantation simultaneously during open heart surgery. Tricuspid annuloplasty was performed with the spiral suspension technique. The leadless pacemaker was anchored to the apical septum of the right ventricle through the tricuspid valve with endoscopic guidance, and left atrial appendage closure was performed for permanent AF. The patient was discharged on postoperative day 18 without major complications. He has been doing well with mild TR on transthoracic echocardiography as of three years post-operation.
[Cardiac Arrest During Thoracic Surgery for Left Lung Cancer].
Satoh H, Matsuda E
Kyobu Geka · 2025 Aug · PMID 40840878
A 69-year-old man was referred to our hospital due to an abnormal chest shadow on computed tomography (CT) scan. He underwent thoracoscopic left upper lobectomy followed by mediastinal lymph node dissection under the fro...
A 69-year-old man was referred to our hospital due to an abnormal chest shadow on computed tomography (CT) scan. He underwent thoracoscopic left upper lobectomy followed by mediastinal lymph node dissection under the frozen-section diagnosis of lung cancer. During the left upper mediastinal lymph-node dissection, grasping fat tissue including cardiac branches of the vagus nerve led to cardiac arrest. It is known that left-side upper mediastinal lymph-node dissection can potentially trigger cardiac arrest. Therefore, it is crucial to proceed surgery with caution and to alert anesthesiologists to pay an attention to the risk of cardiac arrest.
[Aortic Arch Replacement Using Fenestrated Frozen Elephant Trunk Technique for Acute Type A Aortic Dissection with Isolated Left Vertebral Artery].
Tauchi Y, Masuda Z, Mitsui H
Kyobu Geka · 2025 Aug · PMID 40840877
We report a case of acute type A aortic dissection (ATAAD) with an isolated left vertebral artery (ILVA), and our successful surgical treatment with a fenestrated frozen elephant trunk (FET). A 56-year-old man was referr...
We report a case of acute type A aortic dissection (ATAAD) with an isolated left vertebral artery (ILVA), and our successful surgical treatment with a fenestrated frozen elephant trunk (FET). A 56-year-old man was referred to our department for chest and back pain. Contrast enhanced computed tomography (CT) revealed ATAAD. The left vertebral artery branched directly from the aorta. We performed total arch replacement with fenestrated FET to preserve the ILVA and left subclavian artery( LSCA) blood flow. During surgery, the aorta was transected at zone 2, and FET was deployed into the distal aorta, then we manually created a hole on the ILVA and LSCA side in the stented portion. After surgery, angiography confirmed antegrade flow in the ILVA and LSCA. Although care must be taken with the location of the intimal tear, we advocate this technique for treating ATAAD with ILVA in suitable cases.
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