Double Barreled Graft (Chimney) as a Strategy to Preserve Supraortic Branches in Contained Ruptured Thoracic Aneurysm Thoraco Endovascular Aortic Aneurysmal Repair- A Case Report

2021 ◽  
Author(s):  
Rohit Mody
Keyword(s):  
Case Report ◽  
Aortic Arch ◽  
Stent Graft ◽  
Open Surgery ◽  
Thoracic Aortic Aneurysm ◽  
Thoracic Aneurysm ◽  
Complete Coverage ◽  
Hybrid Repair ◽  
Adequate Coverage ◽  
Aortic Branch

Out of many strategies that are used to treat aortic arch disease, including open surgery, branched techniques, and hybrid repair with Thoracic Endovascular Aortic Aneurysmal Repair (TEVAR) and supra-aortic branch reconstruction and fenestration, Thoracic Endovascular Aortic Aneurysmal Repair (TEVAR) incorporating chimney is frequently used in unstable and morbid patients not suitable for other procedures. We describe here a case of contained rupture of a thoracic aortic aneurysm, which was treated with TEVAR incorporating a double chimney to the left common carotid and left subclavian arteries. There was an uncomplicated course of the procedure with complete coverage of aneurysm with stent-graft and open aortic arch vessels when followed up to 6 months. There were no complications noted as well. In this case we took the precaution to upsize the stent-graft by 20% to 30% also for adequate coverage of aneurysm we had to adopt to the chimney technique. To prevent complications like gutter and endoleaks, the kissing technique was used during deployment. In addition, there was adequate coverage of chimney-grafts with adequate proximal projection.

Physician-Modified Endograft With Triple Inner Branches for Extensive Aortic Arch Aneurysm

2021 ◽  
pp. 152660282110594
Author(s):  
Yu Zhang ◽  
Jiayu Shen ◽  
Peng Yang ◽  
Jia Hu
Keyword(s):  
Case Report ◽  
High Risk ◽  
Aortic Arch ◽  
Stent Graft ◽  
Aortic Arch Aneurysm ◽  
Attractive Option ◽  
Arch Aneurysm ◽  
Thoracic Stent Graft

Purpose: The purpose of this case report was to demonstrate the feasibility of a physician-modified endograft (PMEG) with 3 inner branches for extensive aortic arch aneurysm. Case Report: A 69-year-old male presented with extensive aortic arch aneurysm involving all supra-aortic vessels. An Ankura thoracic stent graft was modified with 3 inner branches fashioned of Viabahn endoprostheses. The procedure was technically successful, and the patient was discharged with no complications. Conclusion: This back-table modification of the off-the-shelf endograft is an especially attractive option for complex arch pathologies with urgency and deemed too high risk for reopen surgery.

scholarly journals Hybrid repair of a very late, post-aortic coarctation surgery thoracic aneurysm: a case report

2012 ◽  
Vol 6 (1) ◽  
Author(s):  
Ioan Tilea ◽  
Laszlo Hadadi ◽  
Razvan C Serban ◽  
Brindusa Tilea
Keyword(s):  
Case Report ◽  
Aortic Coarctation ◽  
Thoracic Aneurysm ◽  
Hybrid Repair

scholarly journals Hybrid Repair Combined with Open Surgery and Endografting for Lesions in Right Aortic Arch: Report of Three Cases

2012 ◽  
Vol 5 (1) ◽  
pp. 61-64 ◽  
Author(s):  
Shunsuke Sato ◽  
Hitoshi Matsuda ◽  
Tetsuya Fukuda ◽  
Keitaro Domae ◽  
Yutaka Iba ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Open Surgery ◽  
Right Aortic Arch ◽  
Hybrid Repair

scholarly journals Contained rupture of arch aneurysm managed with total arch, frozen elephant trunk and endograft

2019 ◽  
Vol 2019 (2) ◽  
Author(s):  
Michael Ibrahim ◽  
Roland Assi ◽  
Fenton McCarthy ◽  
Michael A Golden ◽  
Wilson Y Szeto
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Stent Graft ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Arch Aneurysm ◽  
Distal Anastomosis ◽  
Complex Case ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Arch Aneurysm

We here describe a complex case of a 75-year-old man presenting with contained rupture of an aortic arch aneurysm in the presence of a second thoracic aortic aneurysm. He was managed with emergent total arch replacement with frozen elephant trunk. Another stent-graft was used to achieve hemostasis at the distal anastomosis. He later underwent TEVAR extension to manage his second aneurysm in a staged fashion. This case demonstrates a number of important concepts in the evolving interaction between open and endovascular therapies of the aortic arch, particularly in the emergent setting.

Endovascular Solutions for Aortic Arch Diseases: Total and Hybrid

2021 ◽  
Author(s):  
Luca Marco ◽  
Giacomo Murana ◽  
Luigi Lovato ◽  
Gregorio Gliozzi ◽  
Francesco Buia ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Open Surgery ◽  
New Technologies ◽  
Therapeutic Option ◽  
Circulatory Arrest ◽  
Acute Type ◽  
Aortic Diseases ◽  
Increased Risk ◽  
Endovascular Approach

Although the endovascular approach is the therapeutic option of choice for thoracic and abdominal aortic diseases, open surgery is still the treatment of choice for aortic arch diseases. While open surgical repair remains the gold standard treatment for complete aortic arch replacement, it continues to be burdened by high mortality and neurologic complications, especially for patients who require redo surgery. Therefore, in the era of endovascular surgery, it is not surprising that hybrid operating rooms, new technologies, and new approaches are strongly challenging open surgery. Less-invasive endovascular procedures, when used to treat aortic arch diseases, when feasible and indicated, have clear advantages over open surgery, primarily because there is no need for cardiopulmonary bypass, hypothermic circulatory arrest, or cerebral protection. Moreover, patients who have already been treated for acute type A aortic dissection continue to have a considerable risk for future aortic reintervention, which is associated with increased risk for short- and long-term mortality. In light of these advantages, it is clear how selected high-risk patients with aortic arch disease could benefit from the endovascular approach. However, the hemodynamic and anatomic characteristics of the aortic arch make the endovascular approach in this region challenging. In fact, uncorrected stent-graft placement can have fatal consequences for the patient and increase the risk of endoleaks and stroke. To minimize these potential risks, precise and accurate preoperative planning to achieve optimal stent-graft dimensions and implantation is essential together with careful patient selection. Endovascular options for the treatment of aortic arch disease include both hybrid procedures and total endovascular solutions. This manuscript provides an overview of the current strategies for endovascular aortic arch treatment, including the most recent available series on this topic. In addition, a literature search offers insight into the current state of the art.

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