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We present a successful emergency repair of a contained rupture of a type IV thoraco-abdominal aortic aneurysm using a fenestrated stent graft. This case describes a rupture of a thoraco-abdominal aneurysm whilst the patient awaited manufacture of his custom-fenestrated endograft. Following rupture, he was transferred to our unit from his base hosp...
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The off-the-shelf t-Branch device (Cook Medical, Bloomington, Ind) significantly advanced the endovascular treatment of ruptured thoracoabdominal aortic aneurysms. Improved techniques for expeditious implantation of the t-Branch may improve clinical outcomes for this emergent procedure. Currently, implantation is described using axillary and femora...
Citations
... Thoracoabdominal aortic aneurysm (TAAA) still represents a therapeutic challenge. A meta-analysis of 7833 open repairs of TAAAs between 2000 and 2010 found a 10% in-hospital mortality, a 7.5% spinal cord ischemia rate, a 19% incidence of renal failure, and a 36% rate of pulmonary dysfunction. 1 Rupture aggravates the prognosis of TAAA, and mortality of open repair for ruptured TAAA has been up to 55%. 2 The fenestrated or branched stent-graft technique has so far been used infrequently in ruptured TAAA, [3][4][5] mainly because of the need for customization or long modification time of existing stent-grafts. Actually, most of these cases cannot be treated using branched stent-grafts as this complex treatment can be provided in only a few centers having the necessary skills and off-the-shelf devices that are just now being marketed or developed. ...
... To the best of our knowledge, no one has reported treatment of ruptured TAAA with the octopus endograft technique. Although the fenestrated-branched stent-graft technique has been employed in relatively few cases of ruptured TAAA, [3][4][5] the octopus technique, using widely available devices with the parallel stent technique, may represent a more accessible treatment alternative for ruptured TAAA. There are some technical considerations during the planning and procedure. ...
Purpose:
To report the use of the octopus endograft technique to treat a patient with a ruptured thoracoabdominal aortic aneurysm (TAAA).
Case report:
A 46-year-old man was diagnosed with a contained rupture of a 9-cm type V TAAA. The presence of an occluded superior mesenteric artery (SMA), a stenotic celiac trunk, an enlarged inferior mesenteric artery (IMA), and rich collaterals with the SMA and celiac trunk made endovascular repair with the octopus endograft technique appear feasible. Two stent-grafts were overlapped in the thoracic aorta with the short limb of the distal bifurcated stent-graft about 3 cm above the celiac trunk and the long limb at the level of the renal arteries. A limb graft was introduced into the long limb of the bifurcated stent-graft and deployed with the lower end just above the orifice of the IMA. The celiac trunk was embolized. Viabahn stent-grafts were deployed through the bifurcated stent-graft limbs to revascularize the renal arteries. Completion angiography suggested free flow in the renal arteries, though the gutters around the Viabahn stent-grafts generated a moderate endoleak that persisted at 4-month follow-up. The gutters were then sealed with coil embolization, which eliminated the endoleak and induced complete thrombosis in the aneurysm sac at the 6-month follow-up. One-year computed tomography revealed significant sac shrinkage.
Conclusion:
The octopus endograft technique may serve as a feasible, effective, and safe treatment alternative for highly selected patients with ruptured TAAA.
To present a case of successful emergency complete endovascular repair of a ruptured type IV thoracoabdominal aortic aneurysms (TAAA) through chimney technique with off-the-shelf devices.
A 64-year-old man with a free ruptured type IV thoracoabdominal aortic aneurysms. Open access was obtained at both common femoral arteries, both axillary arteries and left common carotid artery. Coveredstent-grafts were locatedundeployed into the target arteries.Aendoprosthesis was released in the suprarenal aorta and soon aftercovered stentswere deployed in renal arteries and superior mesenteric artery. Type Ib and II endoleaks required an adjunctive endovascular treatment.
Total endovascular repair with chimney technique may be the only life -saving option in patients unfit for open surgery and is effective in sealing the aneurysm and maintaining blood flow to the aortic branches.
Copyright © 2015 Elsevier Inc. All rights reserved.
Le prolongement de la zone proximale d'atterrissage pour faciliter la réparation endovasculaire des anévrysmes de l'aorte avec des collets proximaux courts en utilisant la cheminée, la fenestration, ou la technique de prise d'air a été précédemment rapportée. En outre, l'élargissement de la zone distale d'atterrissage en utilisant la technique du périscope a également a été récemment décrit. Dans cette étude, nous avons employé une technique prolongée de la cheminée, « technique de télescopage » pour traiter avec succès un anévrysme rompu de l'aorte thoracoabdominal type III de Crawford chez un patient en insuffisance rénale et avec une artère mésentérique supérieure occluse.
To report midterm outcomes after urgent endovascular repair of ruptured pararenal or thoracoabdominal aortic aneurysms using multiple periscope and chimney grafts to preserve renovisceral branch perfusion and facilitate aneurysm exclusion.
Nine consecutive men (mean age 72±14 years, range 40-88) presenting with ruptured thoracoabdominal (n = 6), pararenal (n = 2), or infrarenal (n = 1) aortic aneurysm underwent urgent endovascular repair with at least 1 periscope graft delivered via a transfemoral access; chimney grafts were installed from an axillary access. In all, 17 periscope and 7 chimney grafts were used to reperfuse 11 renal and 13 visceral arteries in the 9 patients. The aortic aneurysms were excluded using thoracic devices (n = 7), an aortic extension cuff (n = 1), and bifurcated stent-grafts (n = 2).
All procedures were completed without technical complications except for a dislocated stent-graft from the right renal artery; the artery could not be re-accessed, and the right kidney was sacrificed. One patient died of multiple organ failure (11% 30-day mortality). At a mean follow-up of 10 months (range 3-24), 5 of the 9 patients had recovered completely; 3 patients died of unrelated causes. Imaging showed no aneurysm growth in any patient, with a mean 20% shrinkage in aneurysm size. All periscope and chimney grafts remained patent, and no aortic stent-graft migration was observed. Renal function and the glomerular filtration rate remained stable in all patients.
The periscope and chimney graft technique provides a simpler, less invasive way to maintain blood flow to the renovisceral arteries during urgent endovascular aortic repairs. The very low 30-day mortality rate and the stability of the repairs in the midterm are encouraging. This technique has the potential to profoundly influence the treatment of acute aortic pathologies.
Extending the proximal landing zone to facilitate endovascular repair of aortic aneurysms with short proximal necks using the chimney, top-fenestration, or snorkel technique has been previously reported. In addition, extending the distal landing zone using the periscope technique has also been recently described. In this study, we used an extended chimney technique, the "telescoping technique," to successfully treat a ruptured Crawford type III thoracoabdominal aortic aneurysm in a patient with pre-existing renal failure and an occluded superior mesenteric artery.
