Using a Chimney to Make a Sandwich: Salvage of a Multibranched Thoracoabdominal Aortic Endograft with a Type IIIb Endoleak

Annals of Vascular Surgery
Jonathan MisskeyJoel Gagnon

Abstract

The advent of branched and fenestrated aortic endografts has facilitated the treatment of increasingly complex aortic pathology. The management of complications and endoleaks involving the branches and fenestrations of these grafts represents an increasingly significant clinical and technical challenge. A 79-year-old woman developed a rare type IIIb endoleak from a tear in the graft fabric immediately posterior to the celiac axis branch 3 years after the placement of an off-the-shelf branched endograft for a type II thoracoabdominal aortic aneurysm. The patient presented urgently with abdominal pain and a maximal aneurysm diameter of 15.3 cm. The operative plan was to create a chimney graft completely within the original branched endograft to cover the defect and maintain celiac branch flow. The celiac trunk was accessed from a left axillary approach and access for the main endograft body was achieved via the left femoral artery. Two balloon-expandable covered stents were deployed from the celiac branch extending into the main endograft as a chimney and molded to 2 aortic extension cuffs to cover the fabric defect. The resultant configuration was a modified-sandwich graft within the original stent graft and resulted in successf...Continue Reading

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Citations

Dec 16, 2016·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Richard G McWilliamsRobert K Fisher
Apr 5, 2018·The Journal of Cardiovascular Surgery·Christopher LoweGeorge A Antoniou

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