VESS10. Natural History of Target Vessel Endoleaks After Fenestrated-Branched Endovascular Aortic Repair

Purpose: The objective of this study is to report a case of a primary aortoenteric fistula successfully treated with endovascular repair without aortic explant. Case Report: A 48-year-old man presented with a 24-hour history of hematemesis and malena. A computed tomography (CT) abdomen and pelvis demonstrated a 6 cm infrarenal aortic aneurysm with periaortic stranding and contrast enhancement within the lumen of the third part of the duodenum. The patient underwent emergency Endovascular Aortic Repair (EVAR). The patient was discharged on day 8 of his admission on oral antibiotics. He returned 7 weeks postindex procedure and underwent a laparotomy with omental patch repair of the aortic defect. Intraoperative cultures grew candida albicans, and the patient was discharged on lifelong oral Fluconazole and Amoxycillin-Clavulanic Acid. At 18 months postoperatively, the patient was clinically stable with improved appearances on CT aortogram. Conclusion: We discuss the use of EVAR without aortic explant as a possible treatment option in the management of patient with primary aortoenteric fistulae. This may potentially avoid the significant morbidity and mortality associated with aortic explant in suitable candidates without perioperative signs of sepsis.

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Balloon-Anchoring Technique to Stabilize Target Vessel Catheterization in Complex Endovascular Aortic Repair

Journal of Endovascular Therapy ◽

10.1177/1526602819900989 ◽

2020 ◽

Vol 27 (2) ◽

pp. 248-251 ◽

Cited By ~ 1

Author(s):

Franziska Heidemann ◽

Giuseppe Panuccio ◽

Nikolaos Tsilimparis ◽

Fiona Rohlffs ◽

Eltayeb Mohamed Ahmed ◽

...

Keyword(s):

Aortic Aneurysm ◽

Thoracoabdominal Aortic Aneurysm ◽

Covered Stent ◽

Endovascular Aortic Repair ◽

Target Vessel ◽

Femoral Access ◽

Type Iii ◽

Repair Technique ◽

Aortic Repair ◽

Anchoring Technique

Purpose: To describe a bailout technique to stabilize target vessel catheterization in branched endovascular aortic repair. Technique: The technique is demonstrated in a 75-year-old patient with a 75-mm symptomatic type III thoracoabdominal aortic aneurysm that was treated with a t-Branch endograft. If a catheter cannot be advanced for exchange to a more stable guidewire after target vessel catheterization, the balloon-anchoring technique can be applied to stabilize the through-the-branch hydrophilic guidewire. Through a femoral access a catheter and hydrophilic wire are passed outside the device into the target vessel and exchanged with a stiff wire; a semicompliant balloon is advanced over the Rosen wire and inflated in the target vessel, stabilizing the through-the-branch hydrophilic wire and facilitating its exchange with a stiff wire over a catheter or advancement of the bridging covered stent directly. Conclusion: The balloon-anchoring technique adds to the spectrum of bailout techniques that can be applied in cases of challenging target vessel access.

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