Complete brain protection during debranching thoracic endovascular aortic repair

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Aortic Aneurysm Repair

Background:

• Thoracic aortic aneurysms (TAAs) pose significant risks, especially in patients with complex medical histories.
• Coronary artery bypass grafting (CABG) complicates surgical planning for TAA repair due to potential graft injury.
• Endovascular aortic repair (EVAR) offers a less invasive alternative, but severe atheroma presents unique challenges.

Observation:

• A 71-year-old male presented with an asymptomatic saccular TAA and severe distal arch atheroma.
• The patient had a history of CABG, necessitating a strategy to protect bypass grafts.
• Severe atheroma in the aortic arch required careful management to ensure safe endograft deployment.

Findings:

• Thoracic endovascular aortic repair (TEVAR) was chosen over open repair to preserve CABG integrity.
• Percutaneous cardiopulmonary support was utilized to temporarily occlude native forward flow.
• This technique facilitated complete endograft deployment, effectively excluding the aneurysm and preventing perioperative stroke.

Implications:

• This case demonstrates a successful adaptation of TEVAR in a high-risk patient with complex aortic pathology and prior cardiac surgery.
• The described method of flow occlusion during endograft deployment may be a valuable strategy for managing severe atheroma in EVAR.
• This approach highlights the potential for TEVAR to provide safe and effective treatment options for complex TAA cases, minimizing perioperative complications.