Percutaneous transaxillary endovascular repair of a degenerated aortic homograft

Late degeneration is a feared complication of homograft aortic repair. As homograft use is usually associated with graft infection, a second open repair of a complication may be associated to significant mortality. We describe the endovascular exclusion of a degenerated homograft with a contained rupture in a hostile abdomen via a transaxillary approach. The medical history of a 69-year-old male includes prosthetic aorto-biiliac bypass implantation in 2010 due to Leriche syndrome. In 2018, an aorto-duodenal fistula led to a redo bypass surgery using homografts, followed by right femoral amputation. In 2021, the patient was admitted with sudden abdominal pain due to a contained rupture of the homograft. The occluded right allograft limb and the calcified left common femoral artery was not suitable for access. Percutaneous left axillary puncture was performed under general anesthesia. Lesions were crossed and three 8 × 57 mm covered stents were positioned distally, finishing with a 12 × 57 mm graft. For safety reasons, left radial access was performed before closure. After deployment of closure devices, angiography showed near-occlusion of the axillary artery. Patency was restored with a 9 × 37 mm covered stent via the radial access. The patient was discharged on the following day. Follow-up imaging at 30 days showed complete exclusion of the aneurysm sac.