Endovascular Repair of a Thoracoabdominal Aortic Aneurysm With a Patient-Specific Fenestrated-Branched Stent-Graft

Purpose: To describe the technical aspects of a thoracoabdominal aortic aneurysm (TAAA) repair using a patient-specific fenestrated-branched stent-graft. Technique: The technique is demonstrated in a 69-year-old man with a 6.2-cm asymptomatic type III TAAA. A patient-specific fenestrated-branched stent-graft was designed with 2 down-going directional branches for the celiac and superior mesenteric arteries and 2 reinforced fenestrations for the renal arteries. The procedure was performed under general anesthesia and included sequential stenting of the celiac, superior mesenteric, and bilateral renal arteries. The patient was discharged from the hospital on postoperative day 5 with no complications. Follow-up computed tomography angiography demonstrated exclusion of the aneurysm and patent target vessels at 12-month follow-up. Conclusion: This article and illustrated video highlight the steps for procedure planning and implantation of fenestrated and branched endografts. As these techniques continue to evolve, outcomes are expected to be equivalent or improved as compared to those of long-established open repair.

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Complex Endovascular Aortic Repair With a Branched Endograft to Revascularize 5 Renovisceral Vessels and an Intercostal Artery in a Marfan Patient

Journal of Endovascular Therapy ◽

10.1177/1526602819857601 ◽

2019 ◽

Vol 26 (5) ◽

pp. 736-741 ◽

Cited By ~ 1

Author(s):

Ahmed S. Eleshra ◽

Giuseppe Panuccio ◽

Fiona Rohlffs ◽

Martin Scheerbaum ◽

Nikolaos Tsilimparis ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Thoracoabdominal Aortic Aneurysm ◽

Renal Arteries ◽

Endovascular Aortic Repair ◽

Intercostal Artery ◽

Maximum Diameter ◽

Aortic Repair ◽

Custom Made ◽

Marfan Patient

Purpose: To report a case of thoracoabdominal aortic aneurysm (TAAA) repair treated with a multibranched stent-graft including a prophylactic branch for a large intercostal artery in a Marfan patient at risk for spinal cord ischemia (SCI). Case Report: A 43-year-old man with Marfan syndrome presented with a type IV thoracoabdominal aortic aneurysm (TAAA) and history of multiple previous cardiac and aortic operations over the past 28 years. The maximum diameter of the aneurysm was 60 mm. The patient had 2 right renal arteries and 2 reimplanted segmental arteries (1 occluded). With the goal of preserving both right renal arteries and the large intercostal artery, a 6-branch, custom-made stent-graft was planned and manufactured. Bilateral femoral and right brachial artery access was used. The intercostal artery was catheterized and connected to the retrograde branch from a femoral access. Final angiography and predischarge computed tomography angiography (CTA) showed unimpeded flow to all 6 target vessels. The patient was discharged on postoperative day 10 without clinical signs of SCI. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 6 branches. Conclusion: Multibranched endovascular aortic repair with a branch to a large intercostal artery was technically feasible and clinically successful.

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Thoracoabdominal aortic aneurysm open repair with bilateral multiple renal arteries

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.08.241 ◽

2020 ◽

Vol 71 (2) ◽

pp. 635-636

Author(s):

Giovanni Tinelli ◽

Lucia Scurto ◽

Simona Sica ◽

Fabrizio Minelli ◽

Francesca De Nigris ◽

...

Keyword(s):

Aortic Aneurysm ◽

Open Repair ◽

Thoracoabdominal Aortic Aneurysm ◽

Renal Arteries ◽

Multiple Renal Arteries

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In-hospital and mid-term outcome after complex endovascular aortic repair with fenestrated and branched stent-grafts

British Journal of Surgery ◽

10.1093/bjs/znab202.066 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

V Makaloski ◽

D Broger ◽

S Weiss ◽

S Jungi ◽

D Becker ◽

...

Keyword(s):

Stent Graft ◽

Renal Arteries ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Mesenteric Arteries ◽

Hospital Death ◽

Stent Grafts ◽

Term Outcome ◽

Aortic Repair

Abstract Objective The aim of the study is to evaluate in-hospital and mid-term outcome after complex endovascular aortic repair with fenestrated and branched stent-grafts (fEVAR / bEVAR). Methods This is a single-center retrospective analysis from a prospectively collected database of all patients treated electively with fEVAR or bEVAR for para/suprarenal (PAA) and thoraco-abdominal aortic aneurysm (TAAA) between September 2010 and June 2019. In-hospital and mid-term mortality, major adverse events and re-interventions were assessed. Results Fifty-one patient (84% male) with a mean age of 74±7 years were analysed. Eighteen patients (35%) had TAAA, four patients (8%) suprarenal, and 29 patients (57%) pararenal aortic aneurysms. Mean aneurysm diameter was 64±8 mm. Thirty-eight patients (75%) underwent fEVAR and 13 patients (25%) bEVAR. A total of 157 target vessels were incorporated: 22 celiac trunks (CT), 40 superior mesenteric arteries (SMA), 92 renal arteries (RA), two separate hepatic arteries and one splenic artery. No in-hospital death or stroke was recorded. One patient suffered from early postoperative paraplegia and did not recover and one had paraparesis after 38 days and recovered completely. Six patients (12%) with patent renal arteries experienced acute postoperative kidney injury; one required temporary dialysis. Five in-hospital re-interventions were stent-graft related (four bridging stents angioplasty and one iliac leg extension) and seven re-interventions were not stent-graft related. Mean follow-up was 19±17 months. Eleven patients (22%) died during follow-up: nine were not aortic-related and two were unknown. The Kaplan-Meier estimated survival rates at 1 and 2 years were 81% and 77%, respectively. Five renal stents (5%, 5/92) occluded during follow-up: three were successfully recanalized and two remained occluded. Ten stents (three CT, five SMA, and two RA stents required relining after 13±16 months postoperatively, resulting with estimated primary assisted patency at 2 years of 100%, 100%, 93%, and 95% for the CT, SMA, right RA and left RA, respectively. Conclusion Complex endovascular aortic repair with fEVAR / bEVAR for PAA and TAAA is safe with very low early mortality and morbidity. In-stent stenosis/occlusions occurred within the first two years. However, primary assisted patency was high. A surveillance program to detect potential stent-graft related complications is mandatory.

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Combination of Octopus and Periscope Techniques for the Management of Visceral Branches From Type V Thoracoabdominal Aortic Aneurysm: A Case Report

Vascular and Endovascular Surgery ◽

10.1177/1538574418784995 ◽

2018 ◽

Vol 52 (8) ◽

pp. 658-662

Author(s):

Duan Liu ◽

Hui Zhang ◽

Bao Liu ◽

Jiang Shao ◽

Yue-xin Chen ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Aortic Aneurysm ◽

Mesenteric Artery ◽

Spinal Cord Ischemia ◽

Thoracoabdominal Aortic Aneurysm ◽

Endovascular Technique ◽

Type V ◽

Combined Technique

Purpose: To describe an endovascular technique combining the octopus and periscope techniques for the treatment of a patient with type V thoracoabdominal aortic aneurysm in order to protect the patient’s visceral circulation. Case Report: An 84-year-old male patient was hospitalized for type V thoracoabdominal aortic aneurysm involving celiac axis, superior mesenteric artery, and both renal arteries. The patient’s aneurysm was successfully treated by combining the octopus technique and periscope techniques. The 1-year follow-up computed tomography angiography showed that the endograft and the branches were patent. The gutters had thrombosed with no signs of endoleak. No spinal cord ischemia or impairment of the renal function was observed during the follow-up. Conclusions: This case is an example of the successful usage of the combined octopus and periscope techniques in protecting the renovisceral arteries arising from a type V thoracoabdominal aortic aneurysm; this combined technique might be applicable in carefully selected patients.

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Elective visceral hybrid repair of type III thoracoabdominal aortic aneurysm

Vojnosanitetski pregled ◽

10.2298/vsp1203281m ◽

2012 ◽

Vol 69 (3) ◽

pp. 281-285

Author(s):

Ivan Marjanovic ◽

Miodrag Jevtic ◽

Sidor Misovic ◽

Uros Zoranovic ◽

Aleksandar Tomic ◽

...

Keyword(s):

Aortic Aneurysm ◽

Vascular Surgery ◽

Stent Graft ◽

Celiac Trunk ◽

Thoracoabdominal Aortic Aneurysm ◽

Renal Arteries ◽

The Body ◽

Chronic Obstructive ◽

Transverse Diameter ◽

Type Iii

Introduction. According to the classification given by Crawford et al. type III thoracoabdominal aortic aneurysm (TAAA) is dilatation of the aorta from the level of the rib 6 to the separation of the aorta below the renal arteries, capturing all the visceral branch of aorta. Visceral hybrid reconstruction of TAAA is a procedure developed in recent years in the world, which involves a combination of conventional, open and endovascular aortic reconstruction surgery at the level of separation of the left subclavian artery to the level of visceral branches of aorta. Case report. We presented a 75-years-old man, with elective visceral hybrid reconstruction of type III TAAA. Computerized scanning (CT) angiography of the patient showed type III TAAA with the maximum transverse diameter of aneurysm of 92 mm. Aneurysm started at the level of the sixth rib, and the end of the aneurysm was 1 cm distal to the level of renal arteries. Aneurysm compressed the esophagus, causing the patient difficulty in swallowing act, especially solid food, and frequent back pain. From the other comorbidity, the patient had been treated for a long time, due to chronic obstructive pulmonary disease and hypertension. In general endotracheal anesthesia with epidural analgesia, the patient underwent visceral hybrid reconstruction of TAAA, which combines classic, open vascular surgery and endovascular procedures. Classic vascular surgery is visceral reconstruction using by-pass procedure from the distal, normal aorta to all visceral branches: celiac trunk, superior mesenteric artery and both renal arteries, with ligature of all arteries very close to the aorta. After that, by synchronous endovascular technique a complete aneurysmal exclusion of thoracoabdominal aneurysm with thoracic stent-graft was performed. The postoperative course was conducted properly and the patient left the Clinic for Vascular Surgery on postoperative day 21. Control CT, performed 3 months after the surgery showed that the patient's vascular status was uneventful with functional visceral by-pass and with good position of a stent-graft without a significant endoleak. Conclusion. Visceral hybrid reconstruction represents a complementary surgical technique to that with open reconstruction of TAAA. This approach is far less traumatic to a patient, and is especially important in patients with lot of comorbidities, because there is no need for thoracotomy, and ischemicreperfusion injury of the body is reduced to a minimum.

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Evaluation of visible spinal arteries on computed tomography angiography before and after branched stent graft repair for thoracoabdominal aortic aneurysm

Journal of Vascular Surgery ◽

10.1016/j.jvs.2016.10.118 ◽

2017 ◽

Vol 65 (6) ◽

pp. 1577-1583 ◽

Cited By ~ 8

Author(s):

Konstantinos Gallis ◽

Piotr M. Kasprzak ◽

Beatrix Cucuruz ◽

Reinhard Kopp

Keyword(s):

Computed Tomography ◽

Aortic Aneurysm ◽

Stent Graft ◽

Computed Tomography Angiography ◽

Thoracoabdominal Aortic Aneurysm ◽

Before And After ◽

Stent Graft Repair

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Atypical Endoleak Associated With Inadvertent Cannulation of the Ipsilateral Gate in an Ovation Trimodular Stent-Graft

Vascular and Endovascular Surgery ◽

10.1177/1538574417742286 ◽

2017 ◽

Vol 52 (2) ◽

pp. 135-137 ◽

Cited By ~ 1

Author(s):

Geert Maleux ◽

Sabrina Houthoofd ◽

Lien Poorteman ◽

Inge Fourneau

Keyword(s):

Computed Tomography ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Endovascular Aortic Repair ◽

Abdominal Aortic ◽

The Right

We report on a 54-year-old man who presented with an atypical, proximal, intraoperative endoleak after endovascular aortic repair with an Ovation endograft for a 65-mm-diameter abdominal aortic aneurysm. The endografting was complicated by inadvertent bilateral iliac limb insertion into the right gate without cannulation of the left gate. The endoleak was treated by brachial approach: Through the open left gate, the outflow inferior mesenteric artery was coil embolized and the inflow left gate was closed with an Amplatzer plug. Follow-up computed tomography over 3 years showed absence of any endoleak and a stable diameter of the excluded abdominal aortic aneurysm.

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