Step-by-step endovascular repair for thoracoabdominal aortic aneurysm

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Safonova V.M.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-4631-2408

Polyakov R.S.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-9323-4003

Puretskiy M.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-4988-4102

Mardanyan G.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-7442-520X

Kur-ipa K.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-2395-5999

Abugov S.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-7636-4044

Step-by-step endovascular repair for thoracoabdominal aortic aneurysm

Authors:

Safonova V.M., Polyakov R.S., Puretskiy M.V., Mardanyan G.V., Kur-ipa K.A., Abugov S.A.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2024;(12‑2): 7‑17

DOI: 10.17116/hirurgia20241227

Views: 647

Downloaded: 4

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To cite this article:

Safonova VM, Polyakov RS, Puretskiy MV, Mardanyan GV, Kur-ipa KA, Abugov SA. Step-by-step endovascular repair for thoracoabdominal aortic aneurysm. Pirogov Russian Journal of Surgery. 2024;(12‑2):7‑17. (In Russ.)
https://doi.org/10.17116/hirurgia20241227

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OBJECTIVE

To demonstrate successful treatment of a patient with aneurysmal lesions of several aortic segments.

MATERIAL AND METHODS

A patient with myelodysplastic syndrome and pancytopenia underwent endovascular repair for abdominal aortic aneurysm. Aneurysm of common iliac artery and borderline thoracic aortic aneurysm occurred 2 years after surgery. For this reason, the patient underwent repeated surgery with implantation of a modified iliac bifurcation component with favorable immediate result. The patient was discharged with recommendations for further follow-up. However, repeated CT aortography after a year revealed type 1A endoleak and enlargement of thoracic aortic aneurysm. Considering aortic anatomy and comorbidities, the aortic team preferred endovascular multilevel aortic reconstruction.

RESULTS

Stenting for exclusion of type 1A endoleak was impossible. Thus, the patient underwent endovascular thoracoabdominal aortic repair with T-branch device while maintaining blood flow through visceral arteries. The stent graft previously implanted in abdominal position was connected to the T-branch using a physician-modified PTFE stent graft. To seal the system, additional iliac components were simultaneously implanted into the modified stent graft. The last ones were distally landed in iliac stent grafts installed after primary surgery. Stenting of descending aorta was additionally performed.

CONCLUSIONS

Complex intervention allowed reconstruction of the entire aorta in a patient with hematopoietic abnormalities. Currently, such treatment tactics can be used as an alternative to total open surgical approach in comorbid patients.

Keywords:

aortic aneurysm

thoracoabdominal aorta

endovascular prosthetics

Authors:

Safonova V.M.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-4631-2408

Polyakov R.S.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-9323-4003

Puretskiy M.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-4988-4102

Mardanyan G.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-7442-520X

Kur-ipa K.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-2395-5999

Abugov S.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-7636-4044

Received:

12.09.2024

Accepted:

29.09.2024

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