Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm

Thoracoabdominal aortic aneurysm (TAAA) involves both the thoracic and abdominal aorta and surgical treatment requires reconstructing several important visceral branch arteries. Open surgery is considered the standard treatment for TAAA, but it carries high risks and many complications. With the advancement of endovascular techniques, endovascular repair of TAAA has gradually become a new trend in treatment. This article presents a case of a 61-year-old female with TAAA. The patient underwent a follow-up thoracoabdominal CTA after teratoma surgery, which revealed a thoracoabdominal aortic aneurysm (Crawford Type III) extending from the sixth intercostal space to 5 cm below the renal arteries. The challenge in treating this case lay in reconstructing the visceral arteries. The octopus technique, a type of parallel stenting, offers advantages but has inherent technical limitations, such as multiple access routes for simultaneous stent placement, the potential risk of gutter endoleaks, and mutual compression among parallel stents. To avoid these drawbacks, modifications to the octopus technique are necessary. We connected multiple small stent grafts side-by-side and end-to-end to a single branch of the main aortic stent graft. This improved design effectively circumvented the gutter endoleaks and stent compression issues, allowing for sequential visceral artery reconstruction through single upper limb access. This modified octopus technique closely aligns with the design concept of branched stents. This article aims to describe a case of complete endovascular reconstruction of TAAA using the modified octopus technique combined with the external branch technique, providing an in-depth analysis of the specific procedural steps and their clinical application value.