Fenestrated TEVAR combined with distal fEVAR for treatment of an extensive post-dissection thoracoabdominal aneurysm – a case report
DOI:
https://doi.org/10.48750/acv.628Keywords:
Thoracic Aortic Aneurysm, Aortic Dissection, Endovascular Procedures, Fenestrated Endovascular Aneurysm Repair, Custom-made deviceAbstract
BACKGROUND: Proximal sealing in chronic post-type B dissection aneurysms usually requires a landing zone in zone 1 or 2 of Ishimaru. Classically, this has been addressed through hybrid surgery, which involves surgical cervical debranching and TEVAR. We present a case where a proximal fenestrated TEVAR was used for adequate proximal sealing.
CASE-REPORT: A 77-year-old male patient with a history of previous uncomplicated type B aortic dissection presented with a post-dissection extent II thoraco-abdominal aortic aneurysm. The maximum aortic diameter was 5.8cm, and all target vessels arose from the true lumen. To achieve an adequate proximal seal, we aimed to use Ishimaru zone 1 as a total seal and zone 2 as an effective seal. For the prevention of spinal cord ischemia, a staged repair was planned. In the first stage, a fenestrated TEVAR custom-made device was used, including a scallop for the innominate artery and left common carotid and a preloaded fenestration for the left subclavian artery, in addition to a distal tapered thoracic component reaching 5cm above the celiac trunk. In the second stage, a custom-made 4-fenestrated device was used in addition to a proximal bridging thoracic component and a distal custom-made bifurcated graft.
Both procedures were successful, with postoperative imaging confirming adequate exclusion of the aneurysm and preservation of visceral flow.
CONCLUSION: Custom-made device platforms allow a tailored approach for each patient. The fenestrated TEVAR technique enables proximal sealing in the mid-aortic arch, thereby avoiding the need for surgical cervical debranching.
Downloads
References
Spath P, Campana F, Tsilimparis N, et al. Outcomes of Fenestrated and Branched Endografts for Partial and Total Endovascular Repair of the Aortic Arch – A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg [Internet]. 2024;67(1):106–16.
Gouveia e Melo R, Stana J, Prendes CF, Kölbel T, et al. Current state and future directions of endovascular ascending and arch repairs: The motion towards an endovascular Bentall procedure. Semin Vasc Surg [Internet]. 2022;35(3):350–63.
Prendes CF, Banafsche R, Stana J et al. Technical Aspects of Fenestrated Arch TEVAR With Preloaded Fenestration. J Endovasc Ther. 2021;28(4):510–8.
Konstantinou N, Kölbel T, Debus ES, et al. Fenestrated versus debranching thoracic endovascular aortic repair for endovascular treatment of distal aortic arch and descending aortic lesions. J Vasc Surg [Internet]. 2021;73(6):1915–24.
Tsilimparis N, Prendes CF, Rouhani G, et al. Pre-Loaded Fenestrated Thoracic Endografts for Distal Aortic Arch Pathologies: Multicentre Retrospective Analysis of Short and Mid Term Outcomes. Eur J Vasc Endovasc Surg [Internet]. 2021;62(6):887–95.
