Branch thoracic stent graft repair for arch aneurysm

Abstract

Aortic arch aneurysms involving the major vessels of the neck pose great challenges in their repair. Open repair of these aneurysms are associated with a significant morbidity and mortality. The major challenge for endovascular repair of these complex aneurysms is the maintenance of cerebral perfusion during stent implantation and long‐term durability. This paper discusses preoperative planning and technical aspects to successful endovascular repair of a large aortic arch aneurysm involving the distal take‐off of the left subclavian artery.

Aortic arch aneurysm repair with a new branched device

“…In situ fenestration and the chimney graft technique have been proposed, but prolonged endoleaks before definitive sealing, technical difficulties in sizing the devices, and longterm stability are major concerns. 10,15,16 In contrast to these . Three-dimensional reconstruction shows the location of the arch aneurysm and synchronous presence of an ectatic infrarenal aorta (A 4 ).…”

“…17 Follow-up is vital to assess the feasibility and durability of this new technique, which should still be considered anecdotal. Stanley et al 16 published a 6-week follow-up control with good flow through the endograft and exclusion of the aneurysm. The most extensive experience is represented by the six cases published by Lioupis et al, 17 who reported a mean follow-up of 9.6 months with one patient lost.…”

Fenestrated Aortic Arch Stent-Graft Malfunction With Endovascular Salvage

“…The perfect devices for all anatomies and pathologies are not currently available, although manufacturers continue to work to enhance device capabilities and applicability. 12 This patient had been deemed unsuitable for open surgery due to his cardiomyopathy, medical comorbidities, and high surgical risk. For this reason, we were left with no other choice but to find an endovascular solution to the problem faced.…”

“…The perfect devices for all anatomies and pathologies are not currently available, although manufacturers continue to work to enhance device capabilities and applicability. 12…”

Fenestrated TEVAR Using a Guidewire Fixator for Anchoring in Aortic Arch Target Vessels

“…Thoracic endovascular aortic repair (TEVAR) using fenestrated and branched stent-grafts (f/br-TEVAR) is an increasingly utilized treatment method for thoracic aortic arch aneurysm. [1][2][3][4][5] Current practice entails use of a throughand-through guidewire access to the target vessel from a brachial or axillary access to the common femoral artery (CFA) access for a single fenestration or branch to the left subclavian artery (LSA). [6][7][8] Although a through-andthrough wire offers stability and support, a brachial, axillary, or subclavian access involves the risk of hemorrhage and arterial damage.…”