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KMID : 1037520210370040043
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Vascular Specialist International
2021 Volume.37 No. 4 p.43 ~ p.43
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Staged Hybrid Treatment with Branched Endovascular Aneurysm Repair of a Thoracoabdominal Aortic Aneurysm in the Presence of a Total Infrarenal Aortoiliac Occlusion
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Andic Mateja
Lescan Mario
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Abstract
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Aortoiliac occlusive disease may limit the use of branched endovascular aneurysm repair (BEVAR) of thoracoabdominal aneurysms (TAAAs). Thus, infrarenal aortoiliac occlusion may preclude the use of BEVAR. We present a case involving a 67-year-old patient with a fast-progressing TAAA (diameter: 70 mm) and a concomitant total aortoiliac occlusion. A multi-staged treatment concept included the creation of the access and the distal landing zone for the consecutive endovascular procedures through an aorto-right femoral-left popliteal bypass. At six-week intervals, thoracic endovascular aortic repair for the creation of the proximal landing zone and a 4-vessel BEVAR were accomplished. At 36 months, a type III endoleak occurred due to the fracture of the bridging stent-graft to the celiac trunk and the superior mesenteric artery. It was successfully treated with VBX stent-grafts. This case illustrates the importance of a staged hybrid approach in the management of complex aortic pathologies with poor access and insufficient distal landing zone.
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KEYWORD
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Thoracoabdominal aortic aneurysm, Endovascular aneurysm repair, Peripheral artery disease, Endovascular procedures, Arterial occlusive diseases
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