A Novel Off-the-Shelf Technique for Endovascular Repair of Type III and Type IV Thoracoabdominal Aortic Aneurysms Using the Gore Excluder and Viabahn Branches
Mathew Wooster, Paul Armstrong, DO, Murray Shames, MD.
University of South Florida, tampa, FL, USA.
Objective: To describe the use of a novel off-the-shelf technique to repair type III and type IV thoracoabdominal aortic aneurysms (TAAA) in absence of available prefabricated branched devices.
Methods: All patients undergoing endovascular repair of type III and IV TAAAs using this technique were included from a prospectively maintained registry at a regional aortic referral center. The proximal bifurcated Excluder device is deployed with the contralateral gate above the celiac axis. From an axillary approach, through the contralateral gate (and including a single snorkel along side the mainbody),3 or 4 renal and visceral artery branches are sequentially cannulated and stented using Viabahn covered stents. All branches are simultaneous balloon dilated to ensure proximal gutter seal in the contralateral gate. Via the ipsilateral limb, the device can then be extended with a flared iliac extension and/or additional bifurcated device to obtain seal in the distal aorta (previous open repair) or common iliac arteries.
Results: Eight patients (male =6, mean 78 years of age) were identified since January 2015. All underwent repair using Gore C3 device with 3 (n = 5) or 4 (n=3) renovisceral branches. The celiac artery was sacrificed in four patients and one renal artery in one patient. Mean fluoroscopy time was 88.7 minutes with a mean of 92.3cc contrast utilized. Median length of stay was 7 days with 3 days spent in the intensive care unit. No major cardiac, respiratory, renal, neurologic or wound complications occurred. Three patients had early endoleaks treated with additional endovascular techniques (n =2) or open surgical ligation (n =1) during the index hospitalization. Two late endoleaks were identified; one type II with stable sac size and one type III requiring iliac limb relining. All limbs and branches remain patent at the time of the last imaging study.
Conclusion: We present an endovascular technique for repair of type III and IV TAAAs which appears to be both feasible and safe with good short term outcomes.
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