Retrograde in situ branched stent grafting for a patient with type V thoracoabdominal aortic aneurysm

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Aortic Aneurysm Research

Background:

• Thoracoabdominal aortic aneurysms (TAAA) present complex surgical challenges, often requiring extensive open repair or complex endovascular techniques.
• Conventional treatment for TAAA involves significant morbidity and mortality, driving the need for innovative, less invasive solutions.
• Maintaining visceral artery perfusion during endovascular aortic repair is critical for patient outcomes.

Observation:

• A case report of a 76-year-old patient with a type V TAAA.
• The patient underwent retrograde in situ branched stent grafting to the superior mesenteric artery (SMA).
• A percutaneous transhepatic gallbladder drainage needle was utilized for retrograde access to the SMA origin.

Findings:

• Successful stent graft placement into the aorta.
• Retrograde puncture of the stent graft and deployment of a covered stent into the SMA.
• SMA ischemic time was limited to 6 minutes.
• Postoperative imaging confirmed no endoleak and demonstrated aortic sac regression.

Implications:

• This retrograde in situ branched stenting technique offers a potentially less invasive alternative for TAAA repair.
• The method highlights the feasibility of achieving visceral artery revascularization during complex aortic procedures.
• Further research is warranted to evaluate the long-term efficacy and safety of this approach in a larger patient cohort.