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.628Palavras-chave:
Thoracic Aortic Aneurysm, Aortic Dissection, Endovascular Procedures, Fenestrated Endovascular Aneurysm Repair, Custom-made deviceResumo
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.
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Referências
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