Percutaneous thoracic aortic aneurysm repair through transcaval aortic access

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Access Techniques

Background:

• Conventional arterial access is often prerequisite for complex endovascular procedures.
• Patients with extensive iliac occlusive disease may not be candidates for standard arterial approaches.
• Large-bore access is essential for certain interventions, including thoracic aortic aneurysm repair.

Observation:

• A 65-year-old male presented with a large thoracic descending aortic aneurysm and bilateral iliac disease, rendering arterial access unfeasible.
• The patient successfully underwent transcaval access, enabling the deployment of a 22-Fr balloon-expandable sheath.
• A 32 mm × 32 mm × 150 mm Valiant stent graft was successfully deployed via the transcaval access.
• The aorto-vena cava tract was closed using a 12 × 10 PDA occluder device without residual flow.
• Post-procedure CT confirmed successful closure and graft placement.

Findings:

• Successful transcaval access was achieved in a patient with contraindications for conventional arterial access.
• The transcaval approach facilitated the deployment of a large-bore stent graft for thoracic descending aortic aneurysm.
• Effective closure of the aorto-vena cava tract was achieved using a PDA occluder device.

Implications:

• Transcaval access is a viable and potentially life-saving option for complex endovascular procedures in patients with challenging anatomy.
• This technique expands the feasibility of treating thoracic aortic aneurysms in patients with prohibitive iliac disease.
• The successful closure technique using a PDA occluder offers a reliable method for managing the transcaval access site.