Failure of Sandwich Technique for Thoracoabdominal Aneurysm Treated with Custom-Made Fenestrated Endograft

AbstractAn 81-year-old patient presented to the emergency room 5 years after infrarenal endovascular aneurysm repair, with a Type Ia endoleak and a presumable infection of the graft material with Listeria monocytogenes. He was treated with a custom-made fenestrated endograft to seal the endoleak and lifelong antibiotic therapy to suppress the infection. Full explantation of graft material is not always preferable, and endovascular treatment combined with antibiotic suppressive therapy is in some cases an appropriate alternative.

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Descending Thoracic and Thoracoabdominal Aortic Aneurysms: Open and Endovascular Repair

10.2310/vasc.3037 ◽

2013 ◽

Author(s):

Naveed U. Saqib ◽

Robert Y. Rhee

Keyword(s):

Imaging Techniques ◽

Artery Bypass ◽

Preoperative Evaluation ◽

Aortic Aneurysms ◽

Visceral Artery ◽

Thoracoabdominal Aneurysm ◽

Management Options ◽

Thoracic Aortic Aneurysms ◽

Fenestrated Endograft

The prevalence of descending thoracic aortic aneurysms (DTAs) and thoracoabdominal aortic aneurysms (TAAAs) are described. Imaging techniques and classification is given. Preoperative evaluation is described in detail, as prior to proceeding with repair of a DTA or a TAAA, patients must be thoroughly evaluated medically to determine if they are physiologically fit enough for repair. Indications for repair, primarily relating to size of aneurysm, are listed for both DTAs and TAAAs. Repair options and management for DTAs now includes thoracic endovascular aortic repair (TEVAR); its outcomes, benefits, and drawbacks are discussed in detail. The discussion of TAAAs is similar, with indications for repair and surgical management options given: direct open repair; a debranching procedure with subsequent endograft repair; and branched or fenestrated endograft repair. A table lists the symptoms attributable to thoracic and thoracoabdominal aortic aneurysms. Figures show the classification of DTAs; the evaluation of a patient with a thoracic aortic aneurysm; available thoracic endografts; anatomic restrictions for TEVAR; evaluation of a patient with a thoracoabdominal aneurysm; regional spinal cord hypothermic protection; distal aortic perfusion; visceral artery bypass; and a branched endograft. This review contains 8 figures, 3 tables, and 125 references.

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Use of a Custom-made Four-Vessel Fenestrated Endograft to Repair an Enlarging Juxtarenal Aneurysm With Type IA Endoleak After Prior ZFEN Repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.06.072 ◽

2019 ◽

Vol 70 (3) ◽

pp. e47

Author(s):

Tammy T. Nguyen ◽

Jessica P. Simons ◽

Edward J. Arous ◽

Dejah R. Judelson ◽

Andres Schanzer

Keyword(s):

Custom Made ◽

Type Ia ◽

Fenestrated Endograft ◽

Juxtarenal Aneurysm

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Total Percutaneous Femoral Approach for Branched Custom-Made Device Endovascular Repair of Thoracoabdominal Aneurysm

Annals of Vascular Diseases ◽

10.3400/avd.cr.20-00080 ◽

2020 ◽

Vol 13 (3) ◽

pp. 347-350

Author(s):

Benjamin Dak Keung Leong ◽

Feona Sibangun Joseph

Keyword(s):

Endovascular Repair ◽

Thoracoabdominal Aneurysm ◽

Femoral Approach ◽

Custom Made

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Thoracic Endovascular Aneurysm Sealing of a Complex Thoracoabdominal Aneurysm

Journal of Endovascular Therapy ◽

10.1177/1526602817749309 ◽

2017 ◽

Vol 25 (1) ◽

pp. 62-67

Author(s):

Emiliano Chisci ◽

Guido Bellandi ◽

Stefano Michelagnoli

Keyword(s):

Renal Artery ◽

Thoracic Aorta ◽

Thoracoabdominal Aortic Aneurysm ◽

Left Renal Artery ◽

Covered Stents ◽

Descending Thoracic Aorta ◽

Thoracoabdominal Aneurysm ◽

Open Conversion ◽

Type Iv ◽

Custom Made

Purpose: To report bailout treatment of a thoracoabdominal aortic aneurysm using a single Nellix stent and parallel stents. Case Report: A 74-year-old man with multiple comorbidities and a previous fenestrated Anaconda stent-graft for a 60-mm juxtarenal aneurysm was diagnosed with a type IV thoracoabdominal aneurysm on the 2-year computed tomography angiography (CTA) scans. The imaging showed >10-mm downward migration of the proximal Anaconda stent with a massive type Ia endoleak and aneurysmal evolution of the distal descending thoracic aorta; the superior mesenteric artery (SMA) and renal artery covered stents were patent and intact. Open conversion or a second custom-made endograft was not feasible. A plan was devised to use off-the-shelf materials, including the deployment of a single Nellix stent extending from the descending thoracic aorta into the stented area of the fenestrated endograft, with parallel chimney stent-grafts into the SMA and right renal artery; the left renal artery was treated with a bare stent in a periscope configuration. Transient paraparesis was resolved with cerebrospinal fluid drainage. At 6-month CTA, ongoing aneurysm exclusion with patent SMA and renal arteries was confirmed. Conclusion: Thoracic endovascular aneurysm sealing with visceral and renal stenting seems to be a feasible bailout alternative treatment for urgent, complex cases without reconstruction options.

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