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J Endovasc Ther. 2016 Aug;23(4):614-7. doi: 10.1177/1526602816649372. Epub 2016 May 17.

The Loop Technique: Addressing Celiac Artery Dissection in a Branched and Fenestrated Endograft for the Treatment of a Type III Thoracoabdominal Aneurysm.

Author information

1
Section of Vascular and Endovascular Surgery, Yale University, New Haven, CT, USA.
2
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA oderich.gustavo@mayo.edu.
3
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.

Abstract

PURPOSE:

To describe a bailout technique for use during branched/fenestrated thoracoabdominal aortic aneurysm (TAAA) repair to address celiac artery (CA) dissection.

TECHNIQUE:

The technique is demonstrated in a 69-year-old man who underwent fenestrated stent-graft repair of a 6-cm type III TAAA. The main fenestrated stent-graft was positioned without difficulty, and the renal and superior mesenteric arteries were stented. A stent-graft was placed in the CA, but angiography showed the vessel to be occluded by dissection beyond the stent-graft. Wire manipulations to regain access to the true lumen culminated in perforation. At this point, the gastroduodenal artery was catheterized with a 0.035-inch guidewire, which was advanced in retrograde fashion into the CA true lumen and then snared back to the left brachial artery forming a loop. After exchange for a 0.014-inch system, self-expanding stents were deployed into the hepatic artery. Postoperative recovery was uneventful, and the patient was discharged on day 6. At 1-year follow-up, the patient was doing very well. Imaging demonstrated no endoleak, no graft migration, and sac shrinkage to a diameter of 5.1 cm.

CONCLUSION:

The "loop technique" can be a very useful and effective bailout maneuver in regaining access to the true lumen of a dissected CA in patients undergoing branched/fenestrated thoracoabdominal aortic aneurysm repair.

KEYWORDS:

celiac artery; dissection; fenestrated stent-graft; thoracoabdominal aortic aneurysm

PMID:
27189928
DOI:
10.1177/1526602816649372
[Indexed for MEDLINE]
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