Failure of Sandwich Technique for Thoracoabdominal Aneurysm Treated with Custom-Made Fenestrated Endograft

Enrico Maria Marone, Luigi Federico Rinaldi, Domenico Antonio Diaco, Angelo Argenteri

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Custom-made fenestrated and branched endografts are considered the gold standard devices for thoracoabdominal repair, with lower perioperative mortality and morbidities than open surgical repair. Although they are not feasible in urgent and emergent settings, in which sandwich techniques are often necessary, custom-made devices can still be used as bail-out options to correct late complications such as high-flow endoleaks, as shown in this case report.

METHODS: A complex, symptomatic thoracoabdominal aneurysm, unsuitable for open repair, was treated by sandwich technique on the celiac trunk despite having a short distal neck. After the finding of a high-flow type IB endoleak during postoperative follow-up, reintervention was planned with a custom-made endograft with a distal scallop, to preserve patency of the superior mesenteric artery.

RESULTS: The procedure achieved technical success, with complete exclusion of the aneurysm and patency of all the visceral arteries.

CONCLUSIONS: Bail-out endovascular repair with custom-made endografts after failure of parallel graft repair of thoracoabdominal aneurysms is a valuable treatment option preventing the risks related to an open conversion.

Original languageEnglish
Pages (from-to)337.e1-337.e4
JournalAnnals of Vascular Surgery
Volume54
DOIs
Publication statusPublished - Jan 2019

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Aneurysm
Endoleak
Pectinidae
Equipment and Supplies
Superior Mesenteric Artery
Abdomen
Arteries
Morbidity
Transplants
Mortality
bailing

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Failure of Sandwich Technique for Thoracoabdominal Aneurysm Treated with Custom-Made Fenestrated Endograft. / Marone, Enrico Maria; Rinaldi, Luigi Federico; Diaco, Domenico Antonio; Argenteri, Angelo.

In: Annals of Vascular Surgery, Vol. 54, 01.2019, p. 337.e1-337.e4.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Custom-made fenestrated and branched endografts are considered the gold standard devices for thoracoabdominal repair, with lower perioperative mortality and morbidities than open surgical repair. Although they are not feasible in urgent and emergent settings, in which sandwich techniques are often necessary, custom-made devices can still be used as bail-out options to correct late complications such as high-flow endoleaks, as shown in this case report.METHODS: A complex, symptomatic thoracoabdominal aneurysm, unsuitable for open repair, was treated by sandwich technique on the celiac trunk despite having a short distal neck. After the finding of a high-flow type IB endoleak during postoperative follow-up, reintervention was planned with a custom-made endograft with a distal scallop, to preserve patency of the superior mesenteric artery.RESULTS: The procedure achieved technical success, with complete exclusion of the aneurysm and patency of all the visceral arteries.CONCLUSIONS: Bail-out endovascular repair with custom-made endografts after failure of parallel graft repair of thoracoabdominal aneurysms is a valuable treatment option preventing the risks related to an open conversion.",
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T1 - Failure of Sandwich Technique for Thoracoabdominal Aneurysm Treated with Custom-Made Fenestrated Endograft

AU - Marone, Enrico Maria

AU - Rinaldi, Luigi Federico

AU - Diaco, Domenico Antonio

AU - Argenteri, Angelo

N1 - Copyright © 2018 Elsevier Inc. All rights reserved.

PY - 2019/1

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N2 - BACKGROUND: Custom-made fenestrated and branched endografts are considered the gold standard devices for thoracoabdominal repair, with lower perioperative mortality and morbidities than open surgical repair. Although they are not feasible in urgent and emergent settings, in which sandwich techniques are often necessary, custom-made devices can still be used as bail-out options to correct late complications such as high-flow endoleaks, as shown in this case report.METHODS: A complex, symptomatic thoracoabdominal aneurysm, unsuitable for open repair, was treated by sandwich technique on the celiac trunk despite having a short distal neck. After the finding of a high-flow type IB endoleak during postoperative follow-up, reintervention was planned with a custom-made endograft with a distal scallop, to preserve patency of the superior mesenteric artery.RESULTS: The procedure achieved technical success, with complete exclusion of the aneurysm and patency of all the visceral arteries.CONCLUSIONS: Bail-out endovascular repair with custom-made endografts after failure of parallel graft repair of thoracoabdominal aneurysms is a valuable treatment option preventing the risks related to an open conversion.

AB - BACKGROUND: Custom-made fenestrated and branched endografts are considered the gold standard devices for thoracoabdominal repair, with lower perioperative mortality and morbidities than open surgical repair. Although they are not feasible in urgent and emergent settings, in which sandwich techniques are often necessary, custom-made devices can still be used as bail-out options to correct late complications such as high-flow endoleaks, as shown in this case report.METHODS: A complex, symptomatic thoracoabdominal aneurysm, unsuitable for open repair, was treated by sandwich technique on the celiac trunk despite having a short distal neck. After the finding of a high-flow type IB endoleak during postoperative follow-up, reintervention was planned with a custom-made endograft with a distal scallop, to preserve patency of the superior mesenteric artery.RESULTS: The procedure achieved technical success, with complete exclusion of the aneurysm and patency of all the visceral arteries.CONCLUSIONS: Bail-out endovascular repair with custom-made endografts after failure of parallel graft repair of thoracoabdominal aneurysms is a valuable treatment option preventing the risks related to an open conversion.

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JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

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