An Endovascular System for Thoracoabdominal Aortic Aneurysm Repair

Abstract

Purpose:

To describe a stent-graft system for endovascular repair of thoracoabdominal aortic aneurysm (TAAA) that preserves side branch perfusion.

Technique:

The modular endograft system includes 3 components. The primary stent-graft is custom-made from conventional graft fabric and Gianturco Z-stents. Covered nitinol Smart Stents are used for the visceral and renal extensions, and the distal extension is made from a modified Zenith system. With the supine patient under general anesthesia, the components are delivered sequentially through surgically exposed femoral and right brachial arteries in an operation that requires prolonged periods of magnified high-resolution imaging.

This system was first used in a 76-year-old man with a contained rupture of a supraceliac ulcer and a large abdominal aortic aneurysm ending proximally at the celiac artery. The endograft was implanted successfully, but the patient developed paraplegia on day 2; imaging documented an excluded aneurysm and excellent flow through the endograft and all prosthetic branches.

Discussion:

Endovascular repair of TAAA appears to be feasible. If there are no serious, specific, unavoidable complications, the potential advantages are enormous.

Keywords

stent-graft Zenith Gianturco Z-stent visceral vessels paraplegia

Get full access to this article

View all access options for this article.

References

Crawford

DeNatale

. Thoracoabdominal aortic aneurysm: observations regarding the natural course of the disease. J Vasc Surg. 1986;3:578–582.

Svensson

Crawford

Hess

. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17:357–370.

Martin

O'Hara

Hertzer

. Surgical repair of aneurysms involving the suprarenal, visceral, and lower thoracic aortic segments: early results and late outcome. J Vasc Surg. 2000;31:851–862.

Cambria

Davidson

Carter

. Epidural cooling for spinal cord protection during thoracoabdominal aneurysm repair: a five-year experience. J Vasc Surg. 2000;31:1093–1102.

Browne

Hartley

Purchas

. A fenestrated covered suprarenal aortic stent. Eur J Vasc Endovasc Surg. 1999;18:445–449.

Faruqi

Chuter

TAM

Reilly

. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft. J Endovasc Surg. 1999;6:354–358.

Park

Chung

Choo

. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: preliminary experience. J Vasc Interv Radiol. 1996;7:819–823.

Kinney

Kaebnick

Mitchell

. Repair of mycotic paravisceral aneurysm with a fenestrated stent-graft. J Endovasc Ther. 2000;7:192–197.

Inoue

Iwase

Sato

. Transluminal endovascular branched graft placement for a pseudoaneurysm: reconstruction of the descending thoracic aorta including the celiac axis. J Thorac Cardiovasc Surg. 1997;114:859–861.

10.

Wisselink

Abruzzo

Shin

. Endoluminal repair of aneurysms containing ostia of essential branch arteries: an experimental model. J Endovasc Surg. 1999;6:171–179.

11.

Chuter

TAM

Risberg

Hopkinson

. Clinical experience with a bifurcated endovascular graft for abdominal aortic aneurysm repair. J Vasc Surg. 1996;24:655–666.