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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Endovascular correction of a distal re-entry in an abdominal aorta dissection
Marcio Da Rocha1, Salvador Miranda, Marta Burrell
1Division of Vascular Surgery, Thorax Institute, Hospital Clinic, Barcelona, Spain.
Insights
Re-entry tears complicate endovascular aortic repair. A novel U-shaped stent graft successfully treated a complex aortic dissection re-entry tear, preserving pelvic circulation.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Disease
Background:
- Re-entry tears are a significant challenge in endovascular treatment of aortic dissections.
- Standard endovascular aortic repair (EVAR) may not always address complex anatomical variations or complications.
Observation:
- A 60-year-old male patient developed a re-entry tear at the right hypogastric ostium three years post-EVAR for abdominal aortic dissection.
- This complication led to pressurization of the aortic and common iliac aneurysmal sac, necessitating intervention.
Findings:
- A novel approach utilizing a self-expandable, U-configured covered stent was implanted.
- This technique successfully connected the right external and internal iliac arteries, effectively excluding the aneurysmal sac.
- Pelvic circulation was preserved during the intervention.
Implications:
- Flexible stent grafts offer a safe and effective alternative for managing complex re-entry tears in EVAR.
- This approach simplifies procedures in challenging aortic dissection cases.
- Preservation of pelvic blood flow is achievable with innovative stent graft configurations.
Abstract:
The re-entries are still a problem for the endovascular treatment of aortic dissections. A 60-year-old man was treated for an abdominal aortic dissection using aortic monoiliac endograft until the left iliac external artery and a femoro-femoral bypass with occlusion of the right common iliac artery and the left hypogastric artery. In his third year of follow-up, a re-entry tear in the right hypogastric ostium was diagnosed with pressurization of the aortic and common iliac aneurysmatic sac, that required correction. A self-expandable covered stent in a 'U' configuration was implanted, connecting the right external and internal iliac arteries, with preservation of the pelvic circulation, and exclusion of the aneurysmatic sac. In conclusion, the use of a flexible stent graft is a safe alternative, and simplifies some procedures in complex circumstances.
