One-year follow-up after total endovascular repair of a contained-ruptured thoracoabdominal aortic aneurysm with the sandwich technique Theodosios Bisdas,

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Presentation transcript:

One-year follow-up after total endovascular repair of a contained-ruptured thoracoabdominal aortic aneurysm with the sandwich technique Theodosios Bisdas, MD, Konstantinos P. Donas, MD, Michel Bosiers, MD, Giovanni Torsello, MD, Martin Austermann, MD Journal of Vascular Surgery Volume 58, Issue 2, Pages 482-485 (August 2013) DOI: 10.1016/j.jvs.2012.11.066 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Preoperative contrast-enhanced computed tomography (CT) scan shows a contained-ruptured thoracoabdominal aortic aneurysm (rTAAA) (9-cm diameter) and the highly calcified iliac arteries. B, Intraoperative angiography before the intervention. C, Intraoperative kissing-balloon technique of the bridging endografts, the proximal abdominal tube, and the thoracic endograft. Journal of Vascular Surgery 2013 58, 482-485DOI: (10.1016/j.jvs.2012.11.066) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Evidence of endoleak is seen in the intraoperative completion angiography. B, The space (gray arrow) between the coaxial Viabahn grafts (black circles) and the abdominal cuff (white circle) and the main stent graft (gray circle) is defined as the gutter. After the coaxial grafts were molded into the thoracic endograft, the blood still found an exit to the aneurysm sac, leading to gutter-associated endoleak. C, A contrast-enhanced computed tomography (CT) scan on postoperative day 7 confirmed the endoleak. D, A contrast-enhanced CT scan at 2 months shows the persistent endoleak has disappeared. E, A contrast-enhanced CT scan at 12 months shows shrinkage of the aneurysm, thrombosis of the gutter (white arrow), and absence of endoleaks. Journal of Vascular Surgery 2013 58, 482-485DOI: (10.1016/j.jvs.2012.11.066) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 A three-dimensional reconstruction of a contrast-enhanced computed tomography (CT) scan at 12 months shows (A) the total exclusion of the aneurysm, no endograft migration, and the patent superior mesenteric artery (SMA) and celiac artery; (B) the relationship among the coaxial abdominal tubes, bridging stents, and the thoracic endograft; and (C) the exact position of the bridging endograft into the SMA. Journal of Vascular Surgery 2013 58, 482-485DOI: (10.1016/j.jvs.2012.11.066) Copyright © 2013 Society for Vascular Surgery Terms and Conditions