Chimney and Periscope Grafts to Facilitate Endovascular Treatment of Aortic Transection in a Patient With Aberrant Right Subclavian Artery

Abstract

PURPOSE: To report the use of parallel grafts to extend the proximal landing zone for stentgraft repair of aortic transection involving an aberrant right subclavian artery (ARSA). CASE REPORT: A 28-year-old patient was referred for treatment of traumatic aortic transection with contained rupture at the level of an ARSA. Immediate thoracic endovascular aortic repair (TEVAR) was planned because of hemodynamic instability. To achieve rapid sealing and maintain perfusion to both subclavian arteries, a chimney stent to the left subclavian artery (LSA) and a periscope stent-graft to the ARSA were deployed successfully. After surgical repair of all fractures, the patient was discharged 1 month after the initial injury in good condition. Imaging follow-up at 10 months showed a stable repair, patent parallel grafts, and no complications. CONCLUSION: TEVAR with chimney and periscope grafts proved to be a safe and quick treatment for a patient requiring ARSA repair in acute aortic transection. This technique maintained blood flow to the ARSA and LSA in a totally endovascular approach, which could be very valuable in transection cases where bypass surgery to supra-aortic branches is compromised or deemed challenging due to thoracic wall and/or neck trauma. Parallel grafting can be a valuable tool to address any acute aortic pathology as it can be performed with off-the-shelf devices.

Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients

“…11,12 All percutaneous accesses were performed with the preclosure technique (Proglide, Abbott Vascular, Redwood City, CA, USA), 13 under DUS imaging. Axillary percutaneous access was performed using the micropuncture technique to reduce the risk of nerve or plexus damage.…”

Evolution in the Management of Aberrant Subclavian Arteries and Related Kommerell Diverticulum

“…Patients were treated with either open surgery (n [ 9) or an endovascular approach (n [ 13). For the open surgical patients, hypothermic circulatory arrest (n [ 7) or left heart bypass (n [ 2) was used. For those patients undergoing an endovascular approach (n [ 13), carotid to subclavian arterial bypasses were performed preoperatively in 11 patients and intraoperatively in 2 patients.…”

“…Traditionally, open repair has been the preferred treatment modality for ASAs and associated Kommerell diverticulum. However, over the last decade operative techniques have evolved to include endovascular and hybrid approaches for this pathology [6,7]. The purpose of this study is to assess the evolution of management of aberrant subclavian arteries and related Kommerell diverticulum over a 15-year period.…”

Chimney parallel grafts and thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: A systematic review

“…A summary of patient characteristics, stent characteristics and clinical outcomes is detailed in Table 1. From the nine cases examined, [20][21][22][23][24][25] patients had an average age of 41 (three females, five males one unspecified). All patients had significant poly-trauma, secondary to the mechanism of injury.…”