Proximal thoracic endograft displacement rescued by balloon-assisted pull-back, external shunting, and in situ fenestration of the left carotid artery

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Presentation transcript:

Proximal thoracic endograft displacement rescued by balloon-assisted pull-back, external shunting, and in situ fenestration of the left carotid artery Nikolaos Tsilimparis, MD, E. Sebastian Debus, MD, PhD, Sabine Wipper, MD, Sebastian Carpenter, MD, PhD, Christina Lohrenz, MD, Tilo Kölbel, MD, PhD Journal of Vascular Surgery Volume 63, Issue 3, Pages 815-818 (March 2016) DOI: 10.1016/j.jvs.2014.05.043 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Computed tomography scan demonstrating (a) a type B dissection of the thoraco-abdominal aorta encroaching the left subclavian artery (LSA) and (b) true lumen collapse at the level of the renal arteries (arrow) causing malperfusion of the right renal artery. Journal of Vascular Surgery 2016 63, 815-818DOI: (10.1016/j.jvs.2014.05.043) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 a, Angiography confirmed coverage of the left common carotid artery (LCCA) by the proximally migrated endograft and (b) with help of external tubing (dashed arrow), the 20-French (F) sheath in the right common femoral artery was connected to the LCCA sheath, thus providing antegrade perfusion to the LCCA (solid arrow) during the rest of the procedure. Journal of Vascular Surgery 2016 63, 815-818DOI: (10.1016/j.jvs.2014.05.043) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 a, A V12 Advanta covered graft (Atrium/Maquet Getinge Group, Rastatt, Germany) was deployed in the in situ fenestration of the left common carotid artery (LCCA) and (b) final angiography confirmed antergrade flow to the brachiocephalic trunk and the LCCA (cross) and occluded left subclavian artery (LSA; x). Journal of Vascular Surgery 2016 63, 815-818DOI: (10.1016/j.jvs.2014.05.043) Copyright © 2016 Society for Vascular Surgery Terms and Conditions