Implantation of an endovascular covered stent-graft for distal aortic arch aneurysm via midsternotomy under pigtail catheter guidance.

We implanted an endovascular covered stent-graft for distal aortic arch aneurysm involving the left subclavian artery in 12 cases. A stent-graft was delivered just below the aneurysm via aortotomy with direct vision using a 12 F delivery sheath under guidance of a pigtail catheter placed via the groin artery. The proximal anastomosis of the stent-graft was performed with inclusion technique, and the aortotomy was then closed with it. This technique reduces operative damage by eliminating distal anastomosis and should reduce operative mortality and morbidity.