Adjunctive embolization of target vessel dissections to improve suitability for fenestrated-branched endovascular...

Suitability of renal-mesenteric target arteries is an essential criterion for fenestrated-branched endovascular aortic repair (FB-EVAR). We describe a staged adjunctive technique of target vessel false lumen (FL) embolization to improve suitability for FB-EVAR in patients with chronic postdissection thoracoabdominal aortic aneurysms (PD-TAAA) and dissection extension into the superior mesenteric artery (SMA). Three patients with SMA dissection and ectasia (diameter > 12-14 mm) underwent staged FL embolization with pre-emptive stent placement to optimize SMA incorporation. Using bilateral transfemoral access with intravascular ultrasound guidance, the proximal SMA true lumen was stented with an 8 L × 39 mm VBX balloon-expandable stent graft (W. L. Gore & Associates) coupled with a 14 × 60 mm bare-metal self-expandable stent extending past the dissection flap reentrance. The SMA FL was then embolized using 15 mm IMPEDE-FX polymer plugs (Shape Memory Medical), followed by postdilatation with a 12 to 14 mm angioplasty balloon. FB-EVAR was completed as a second-stage procedure without complications. Follow-up computed tomography angiography confirmed successful target vessel incorporation without endoleak in all three patients. Staged adjunctive target vessel FL embolization is technically feasible and improves suitability for FB-EVAR in patients with postdissection thoracoabdominal aortic aneurysms and dissected SMA. Larger series and longer follow-up are needed to assess durability and secondary complications.