Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy

Abstract

Purpose: To present a case of endovascular repair using a custom-made 7-branch stent-graft for a thoracoabdominal aortic aneurysm (TAAA) in a patient with variations in the renovisceral artery anatomy. Case Report: A 70-year-old asymptomatic man presented with a 60-mm-diameter type IV TAAA. Due to severe coronary artery disease, an endovascular approach was elected. In the preoperative computed tomography angiography (CTA) scans, variations in the renovisceral artery anatomy included the common hepatic and splenic arteries deriving separately from the aorta and bilateral double renal arteries (RAs). A custom-made 7-branch stent-graft was manufactured to preserve all renovisceral arteries. The 7 branches were catheterized and connected with a steerable sheath from a femoral access. All branches were bridged to the target vessel (TV) with a self-expanding covered stent; 4 TVs also had balloon-expandable covered stents implanted. Final angiography and predischarge CTA showed patency of all 7 target vessels and corresponding visceral organs, with no endoleak. The patient was discharged on postoperative day 8 without complications. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 7 target vessels. Conclusion: Successful treatment of a TAAA in a patient with multiple variant renovisceral arteries was feasible with a custom-made 7-branch stent-graft, achieving a good early outcome.

Expanding the Anatomical Feasibility of Branched Stent-Grafts in Patients With Variant Visceral Vessel Anatomy

“…Nevertheless, the anatomical feasibility of off-the-shelf stent-grafts has been demonstrated to be quite limited, in part due to variations of renal and visceral anatomy. [10][11][12] Conversely, patient-specific devices have the potential to address different anatomical configurations, such as the one presented in the current case report, 4 which reiterates the importance of continued utilization of such devices instead of a complete and exclusive transition to off-the-shelf devices.…”

“…13,14 Moreover, the ability to select branches or fenestrations can certainly be utilized to accommodate a wider variety of anatomies, thus facilitating the procedure based on the specific anatomy of the patient being treated. In this case, particularly, as pointed by the authors, 4 having branches instead of fenestrations was helpful during the procedure as their use provided additional space for catheter/wire manipulation into target vessels. Additionally, branches tend to have a more "forgiving" nature compared with fenestrations, which should be deployed precisely in apposition with their target vessels.…”

“…The case reported by Eleshra and associates 4 in the April 2020 issue of the JEVT, illustrates successful treatment of a patient with a Crawford extent IV TAAA with significant variations of usual anatomy, including bilateral "double" renal arteries of similar size and both common hepatic and splenic arteries originating from the aorta. This complex anatomy was addressed with a patient-specific custom-made stent-graft with 7 branches to all 4 renal arteries, the common hepatic artery, the splenic artery, and the superior mesenteric artery.…”

Insights on Bridging Stent Grafts in Fenestrated and Branched Aortic Endografting

“…Technical experience and improved device design over time have allowed physicians to overcome multiple branches. Most recently, Eleshra et al [5] reported successful management of a patient with variant visceral vessel anatomy (bilateral double renal arteries with both common hepatic and splenic arteries originating from the aorta) with a stent graft with seven…”

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…However, follow-up examinations through 5 years will continue to assess the long-term results. Up to 7 branches have been described in case of variants of visceral arteries [176]. Physician-modified fenestrated stent grafts (PMSGs) are a useful option for urgent or semiurgent treatment of complex abdominal aortic aneurysms.…”