Complex Endoascular Aortic Arch Repair Utilizing Laser In-situ Fenestration For Thoracic Aneurysm Type 1A Leak
Callie D. McAdams, MD, Scott L. Stevens, MD, Mitchell H. Goldman, MD, Michael M. McNally, MD
University of Tennessee Medical Center, Knoxville, TN, USA
DEMOGRAPHICS: 68-year-old male with a 7 cm thoracic aneurysm after type B aortic dissection who had a previous thoracic endovascular aortic aneurysm stent graft placed with concomitant left carotid to subclavian bypass who developed a type IA endoleak.
HISTORY: Patient presented to ambulatory clinic for surveillance of his previously placed thoracic endovascular aortic graft from 2016. Follow-up CT angiography demonstrated a type IA leak with enlargement of the previous aneurysm. The patient was asymptomatic. Past medical history included atrial fibrillation, chronic kidney disease, moderate mitral and tricuspid valve regurgitation, and hypertension.
PLAN: In order to achieve adequate proximal seal to exclude the type IA endoleak, coverage of the left carotid would be required. Retrograde laser in-situ fenestration technique for the left common carotid artery was selected. The patient was consented about the risks, benefits, and utilization of an off label use of an FDA approved device (Spectronectics athrectomy catheter). Exposure of the left common carotid was performed with sheath and catheter positioning before placement of the thoracic aorta endovascular stent graft. The aortic stent graft was deployed just distal to the innominate artery with coverage of the left common carotid artery. Retrograde in-situ laser fenestration was performed and subsequent placement of a Gore 8L VBX stent in the left carotid was performed. Completion angiography demonstrated inline flow of the innominate artery and left carotid artery stent with filling of the previous carotid-subclavian bypass. There no evidence of a type IA endoleak. The patient was discharged on post-operative day 1; follow up CT angiography continues to show no evidence of endoleak and a stable aneurysm.
DISCUSSION: In-situ laser fenestration technique in complex endovascular aortic surgery is a feasible alternative option in challenging aortic arch anatomy. This case demonstrates a successful utilization of this technique with good early outcome.
Back to 2021 Abstracts