1Javairiah Fatima

1Medstar Health

Background(s):

Thoracoabdominal aortic aneurysms (TAAA) secondary to complex aortic dissections are a challenging pathology to treat, with significant morbidity and mortality associated with open repair even in patients deemed to be good risk. Herein we present a physician modified endograft used for total endovascular repair of a complex TAAA.

Material(s) and Method(s):

A 55 year old patient with history of Type A Dissection, ascending aortic replacement s/p arch debranching (innominate, and left common carotid artery), carotid-subclavian bypass and an antegrade thoracic endovascular stent graft placement (TEVAR) presented with an enlarging TAAA. A Cook Alpha thoracic endovascular device was modified back table to create a stent graft with 5 fenestrations customized to the patient’s anatomy and implanted.

Result(s):

Patient underwent a 5 vessel fenestrated endovascular stent graft repair of his aortic aneurysm in a staged fashion. Initial stage included implantation of the modified alpha device with bridging stents into celiac axis, superior mesenteric artery, 2 left renal arteries and one right renal artery.  Patient was discharged on POD 3 and then brought back as an outpatient in a month to embolize three sets of lumbar arteries and complete expansion of the iliac stent in the dissected right common iliac artery, completing the repair. Patient did very well with excellent integrity of repair on postoperative CT scan and no endoleak.

Conclusion(s):

Physician modified endovascular repair of complex thoracoabdominal aortic repairs is feasible and provides a durable repair for patients who otherwise may be unfit for open surgery.