Bailout Maneuvers to Avoid Brain Infarct During Aneurysm Exclusion Using the Nexus™ Endograft: A Case Report

The aim of this study is to report our experience with a complication that occurred during a single-branch aortic arch endograft deployment for a symptomatic aortic aneurysm exclusion. An 85-year-old patient was diagnosed with an aortic arch and descending aortic aneurysm associated with chest pain and dyspnea. After a multidisciplinary discussion, we selected an endovascular approach using an off-the-shelf device for the arch (Nexus™ endograft; Endospan) with a single branch for the brachiocephalic trunk (BCT). Supra-aortic trunks debranching (right common carotid-left subclavian bypass and left common carotid artery reimplantation) was planned in the same procedure. After an uneventful main module deployment, the release of the ascending graft was followed by the sudden occlusion of the endograft branch. Suspecting the branch coverage by the ascending module, a relining of the branch using the through-and-through guide wire was performed restoring brain perfusion. The post-operative course was uneventful as well during the follow-up (6 months). In our experience, the Nexus™ endograft (Endospan) presents peculiar technical features that provide great main module deployment stability and allow for rapid bailout maneuvers if complications occur.