Abstract
Successful placement of endovascular stent-grafts in the aorta requires sufficient landing zones proximally and distally. The amount of stent-graft migration and consequent endoleaks is related to the length of these sealing zones.1,2 In thoracic endovascular aortic repair (TEVAR), should the descending thoracic aortic aneurysm (DTAA) involve the celiac trunk, several options to preserve the endovascular approach have to be discussed. An entirely endovascular approach is feasible with branched and fenestrated stent-grafts,3,4 but beyond the anatomical limitations, the manufacturing of these custom-made devices is currently highly sophisticated and time-consuming, therefore not available in urgent cases. Open vascular debranching of the celiac trunk, the superior mesenteric artery (SMA), and the renal arteries prior to endovascular aneurysm exclusion entails inherent morbidity and mortality.5–8 Alternatively, if only the celiac trunk is involved in the DTAA, the intended coverage of the celiac trunk by the stent-graft should be possible due to a sufficient collateral supply through the SMA.
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