Simultaneous endovascular treatment of synchronous symptomatic acute type B aortic dissection and large infrarenal aortic aneurysm. Technical tips and case report

Tortomasi

et al. 2021

Introduction Carotid artery stenting (CAS) has been indicated as an alternative to carotid endarterectomy in high risk patients. Sometimes, an aortic arch can be anatomically unfavourable for CAS. Herein we report our experience in a case of CAS with transcervical approach. Presentation of case A 77-year-old male was referred to our hospital for severe subtotal occlusion of the left internal carotid artery. He had a past medical history of radiation to the head and neck for laryngeal cancer. Previous CT-angiography had shown a type III aortic with bovine arch. CAS via transcervical approach was performed with transitory reversal flow during the placement of RX Spider Filter 6 Fr (Medtronic, Minneapolis, MN). After release of 7 × 30 mm RX Xact carotid stent (Abbott Vascular, Chicago, IL) and ballooning with a 5.5 × 30 mm Rx Submarine balloon catheter (Medtronic Minneapolis, MN), angiography check showed a good result. Discussion The transcervical approach is an innovative technique where usually a shunt is created, either between the common carotid artery and the internal jugular vein or between the common carotid artery and the common femoral vein. This flow reversal reduces the risk of periprocedural embolic events. In our experience a short proximal clamping with transitory reversal flow, reduces the invasiveness of procedure with good outcomes. Conclusion Transcervical carotid access with transitory reversal flow is a valid alternative in complicated patient with anatomy unfit for CAS.

Section: Discussionmentioning

confidence: 99%

Transcervical approach for carotid artery stenting with transitory reversal flow: Case report

Tortomasi

et al. 2021

“…An open solution (Extrathoracic carotid-to-subclavian artery bypass) was excluded and an endovascular approach was only option. Recently, the chimney endograft technique has been reported to be a feasible endovascular approach to maintain LSA flow [ 4 , 11 ]. However, the chimney endograft might destabilize the proximal landing zone of the aortic stent-graft and has been suspected of increasing the risk of type Ia endoleak [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…To maintain LSA perfusion a periscope was planned. Thus, a “through and through wire” from the left CFA to the left BA (bodyfloss technique) [ 4 ] was constructed in consideration of the arch anatomy and to create a stable platform for the stent-graft advancement and deployment. A viabahn 10 × 150 cm (W. L. Gore & Associates, Flagstaff, Ariz, USA) was released inside the left subclavian artery with periscope technique.…”

Section: Case Reportmentioning

confidence: 99%

TEVAR and periscope graft technique to treatment of huge aneurysm of aortic isthmus: Case report

Marca

et al. 2021

Introduction Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms. Innovative techniques as chimney and periscope grafts can improve the outcomes of procedure. Herein, we report a case in emergency of huge Thoracic aortic aneurism. Presentation of case An 86-year-old male with hypertension, diabetes mellitus, was referred to our hospital for chest pain. CT-angiography showed a huge aneurysm of aortic isthmus with signs of rupture. The patient was considered unfit for open surgery and an endovascular approach was chosen. This patient underwent endovascular repair with TEVAR, using the periscope graft technique to preserve patency in left subclavian artery (LSA). Discussion Symptomatic ischemia from LSA coverage has been reported to occur in only a modest 6–10% of patients and is often sacrificed with impunity given coverage rates between 10 and 50%. In this case reported the lack of revascularization of LSA increased the risk of neurological manifestations or stroke. Periscope technique is feasible and safe to maintain perfusion to the subclavian artery, with a 93% primary patency at 2 years. Conclusions Our experience using TEVAR with periscope graft technique as solution to address thoracic aneurysm of aortic isthmus was feasible and safe.

“…A problematic landing zone in aortic arch can be approached by special thoracic grafts [7] . These, originally developed from stent grafts designed for the infrarenal aorta, were undergone successive iterations to become more well-suited to the specific anatomic challenges presented by the thoracic aorta [8] . The Bolton Relay Thoracic Stent Graft with Plus Delivery System (Bolton Medical, Sunrise, Fla) is a modular device with curved nitinol wire providing flexibility, torque response, and columnar support, was designed specifically to handle the curvature and tortuosity of the thoracic aorta [9] .…”

Section: Discussionmentioning

confidence: 99%

Penetrating aortic ulcer post migration of thoracic aortic endoprosthesis: Case report

Tortomasi

et al. 2021

Introduction Thoracic endovascular aortic repair (TEVAR) is the first treatment option for many thoracic aortic pathologies. Especially after aortic dissections, it is possible to have progression during follow-up with appearance of new lesions on arterial wall. Herein, we report a case of Penetrating Aortic Ulcer (PAU) post release of Thoracic endoprosthesis. Presentation of case A 67-years-old male with hypertension and diabetes mellitus was followed at our hospital after an emergency procedure for Type B aortic dissection (TBAD) complicated by symptomatic large infrarenal AAA and treated with a proximal TEVAR plus chimney for left subclavian artery and PETTICOAT with EVAR for abdominal aortic disease. Follow up at 15 months showed a deep PAU with partial crush of stent in Left Subclavian Artery. Thus, we performed a left carotid-subclavian bypass and subsequently a TEVAR procedure with release of Bolton Relay endoprosthesis (Terumo Aortic, Sunrise, Florida, United States). Discussion In literature there are few studeis that focus on migration after TEVAR during follow-up. Elongation, changes of tortuosity on thoracic aorta after TEVAR, can help to determine a migration of prosthesis. In this case Bolton Relay endoprosthesis (Terumo Aortic, Sunrise, Florida, United States) has permitted to improve precision and quality of procedure. Conclusion In literature there are few studies reporting complications of TEVAR post prosthesis migration. In this case, Bolton Relay endoprosthesis was useful and safe.