Direct Abdominal Aortic Access for Thoracic Endovascular Aortic Repair in a Patient with Severe Aortic and Arterial Calcification

Area of Science:

• Vascular Surgery
• Cardiovascular Imaging
• Interventional Cardiology

Background:

• Aortic and arterial calcification complicates advanced atherosclerosis, posing intraoperative challenges for stent graft procedures.
• Standard transfemoral or iliac access may be infeasible in cases with extensive calcification.
• Thoracic endovascular aortic repair (TEVAR) requires adequate vascular access for stent graft delivery.

Observation:

• A challenging case of TEVAR for a thoracic aortic aneurysm with severe aortic and arterial calcification is presented.
• The patient had a severely limited noncalcified area in the infrarenal abdominal aorta, complicating standard access.
• A direct transabdominal aortic approach was utilized for stent graft introduction.

Findings:

• The direct transabdominal aortic approach provided a feasible access route despite severe calcification.
• Successful stent graft introduction was achieved using this alternative access strategy.
• This approach facilitated the completion of thoracic endovascular aortic repair.

Implications:

• Direct transabdominal aortic access may be a valuable strategy for TEVAR in patients with extensive aortic and arterial calcification.
• This technique expands treatment options for complex aortic aneurysms where conventional access is not possible.
• Further research could explore the safety and efficacy of this approach in a larger patient cohort.