Percutaneous In situ Left Subclavian Artery Fenestration Using Reentry Catheter during Endovascular Thoracic Aortic Aneurysm Repair

Abstract

Left subclavian artery (LSA) revascularization is recommended during elective thoracic endovascular aortic aneurysm repair (TEVAR) when coverage is required for adequate proximal seal. Reported method for LSA revascularization includes open bypass, covered stent placement using chimney technique, and in situ laser fenestration. We reported a novel technique using percutaneous Outback reentry device for LSA revascularization in a 68-year-old male patient who underwent TEVAR for a 9-cm thoracic aortic aneurysm. This technique can be used as an alternative method for LSA in situ fenestration, and laser equipment is not required.

Keywords

endovascular repair - thoracoabdominal aortic aneurysm - subclavian - aneurysm - endograft placement - endovascular procedure - subclavian stenosis

• References

• 1 Walsh SR, Tang TY, Sadat U , et al. Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results. J Vasc Surg 2008; 47 (5) 1094-1098
• 2 Svensson LG, Kouchoukos NT, Miller DC , et al; Society of Thoracic Surgeons Endovascular Surgery Task Force. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg 2008; 85 (1, Suppl): S1-S41
• 3 Lee WA, Matsumura JS, Mitchell RS , et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 2011; 53 (1) 187-192
• 4 Xenos ES, Abedi NN, Davenport DL , et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008; 48 (5) 1343-1351
• 5 Feezor RJ, Martin TD, Hess PJ , et al. Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR). J Endovasc Ther 2007; 14 (4) 568-573
• 6 Burks Jr JA, Faries PL, Gravereaux EC, Hollier LH, Marin ML. Endovascular repair of thoracic aortic aneurysms: stent-graft fixation across the aortic arch vessels. Ann Vasc Surg 2002; 16 (1) 24-28
• 7 Matsumura JS, Lee WA, Mitchell RS , et al; Society for Vascular Surgery. The Society for Vascular Surgery Practice Guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg 2009; 50 (5) 1155-1158
• 8 Morasch MD, Peterson B. Subclavian artery transposition and bypass techniques for use with endoluminal repair of acute and chronic thoracic aortic pathology. J Vasc Surg 2006; 43 (Suppl A): 73A-77A
• 9 Redlinger Jr RE, Ahanchi SS, Panneton JM. In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization. J Vasc Surg 2013; 58 (5) 1171-1177
• 10 Kawaguchi S, Yokoi Y, Shimazaki T, Koide K, Matsumoto M, Shigematsu H. Thoracic endovascular aneurysm repair in Japan: Experience with fenestrated stent grafts in the treatment of distal arch aneurysms. J Vasc Surg 2008; 48 (6, Suppl): 24S-29S , discussion 29S
• 11 Buth J, Harris PL, Hobo R , et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg 2007; 46 (6) 1103-1110 , discussion 1110–1111
• 12 Rizvi AZ, Murad MH, Fairman RM, Erwin PJ, Montori VM. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg 2009; 50 (5) 1159-1169
• 13 Maldonado TS, Dexter D, Rockman CB , et al. Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization. J Vasc Surg 2013; 57 (1) 116-124
• 14 Cho JS, Makaroun MS. Thoracic and thoracoabdominal aneurysms: endovascular treatment. In: Cronenwett J, Johnston W, , eds. Rutherford's Vascular Surgery. 7th ed. Philadelphia, PA: Elsevier; 2010
• 15 Gehringhoff B, Torsello G, Pitoulias GA, Austermann M, Donas KP. Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches. J Endovasc Ther 2011; 18 (5) 650-655
• 16 Setacci C, Chisci E, de Donato G, Setacci F, Iacoponi F, Galzerano G. Subintimal angioplasty with the aid of a re-entry device for TASC C and D lesions of the SFA. Eur J Vasc Endovasc Surg 2009; 38 (1) 76-87