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Back-Table Surgeon Modification of a t-Branch.
Martin Scheerbaum1, Tilo Kölbel1, Fiona Rohlffs1
1Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Annals of Vascular Surgery
|July 26, 2017
Summary
Surgeon modifications to aortic stent grafts offer a vital solution for complex aortic diseases. Customizing off-the-shelf t-branches successfully treated a challenging visceral aortic aneurysm in a high-risk patient.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Aortic Pathology Management
Background:
- Complex aortic pathologies in high-risk patients often require innovative surgical solutions.
- Commercially available aortic stent grafts can be modified by surgeons as a salvage strategy.
- Previous treatments for aortic disease may lead to complex anatomical challenges.
Observation:
- A 68-year-old male presented with a contained rupture of the visceral aorta.
- The patient had a history of infrarenal tube graft and a Crawford procedure with island patch for the celiac trunk (TC) and superior mesenteric artery (SMA), along with renal artery bypasses.
- Computed tomography revealed a "blowout aneurysm" of the TC and SMA patch, with the left renal artery bypass originating from the TC level.
Findings:
- A commercially available t-branch stent graft was modified with surgeon-made fenestrations for both renal arteries.
- The modified t-branch was successfully deployed to treat the complex aortic pathology.
- The patient experienced a successful outcome and was discharged on postoperative day seven.
Implications:
- Surgeon-modified t-branches expand treatment options for challenging aortic anatomies.
- This technique broadens the applicability of off-the-shelf devices for complex aortic pathologies.
- Customization of aortic stent grafts can provide effective solutions for previously untreatable cases.
