Endovascular Solutions for Thoracic Aortic Aneurysms with Challenging Anatomies

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Biomedical Engineering

Background:

• Thoracic endovascular aortic repair (TEVAR) is limited by proximal and distal landing zone suitability.
• Custom-made scalloped stent grafts have emerged as a solution for challenging thoracic aortic anatomies.

Purpose of the Study:

• To evaluate the safety and efficacy of custom-made scalloped stent grafts in treating complex thoracic aortic aneurysms (TAAs).
• To present three cases with unique hostile anatomies successfully managed with this technology.

Main Methods:

• Three patients with TAAs and hostile landing zones were treated.
• Procedures involved custom-made scalloped stent grafts, with some cases requiring adjunctive bypass or embolization.
• TEVAR was performed using scallops to achieve adequate proximal or distal sealing.

Main Results:

• All three cases involved complex TAAs with inadequate landing zones.
• Successful sealing was achieved in all patients using scalloped stent grafts, with or without adjunctive procedures.
• No endoleaks, device migrations, or re-interventions were reported at 1-year follow-up.

Conclusions:

• Custom-made scalloped thoracic stent grafts are a safe, reproducible, and effective minimally-invasive option.
• This technology expands endovascular treatment possibilities for patients with hostile descending thoracic aortic anatomy.