Dissected thoracoabdominal aortic aneurysm repair with modified parallel endografting

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Thoracoabdominal aortic aneurysms (TAAA) pose significant surgical challenges, especially when complicated by dissection and re-entry.
• Previous treatments for this patient included open surgical repair (Bentall procedure, hemiarch replacement) and prior endovascular interventions.
• The patient presented with a large (70 mm) dissected TAAA and re-entry at bilateral common iliac arteries.

Observation:

• Preoperative computed tomography (CT) demonstrated a previously placed thoracic endograft extending from the distal arch to the superior mesenteric artery.
• The TAAA measured up to 70 mm in diameter.
• Computed tomography identified re-entry tears at both common iliac arteries.

Findings:

• A successful endovascular treatment was performed using a fenestrated stent graft.
• This approach created a landing zone for a parallel endograft technique.
• The intervention effectively closed the re-entry tears in the iliac arteries.

Implications:

• This case highlights the feasibility of complex endovascular aortic repair in challenging anatomies.
• Fenestrated stent grafts and parallel techniques offer viable solutions for managing aortic aneurysms with distal re-entry.
• Minimally invasive endovascular strategies may provide effective treatment options for complex thoracoabdominal aortic pathology.