A Novel Off-the-Shelf Technique for Endovascular Repair of Type III and IV Thoracoabdominal Aortic Aneurysms Using the Gore Excluder and Viabahn Branches

摘要

Background The aim of this study is to describe the use of a novel off-the-shelf technique to repair type III and type IV thoracoabdominal aortic aneurysms (TAAAs) in the absence of available prefabricated branched devices. Methods All patients undergoing endovascular repair of type III and IV TAAAs using this technique were included from a prospectively maintained registry at a regional aortic referral center. The proximal bifurcated Gore C3 Excluder device is positioned in the descending thoracic aorta with the contralateral gate 23燾m above the celiac artery. From an axillary approach, the contralateral gate renovisceral branches are sequentially cannulated and simultaneously stented using Viabahn covered stents. In cases were the celiac artery could not be excluded, a parallel stent (snorkel) was added adjacent to the proximal endograft. All branches are simultaneously balloon dilated to ensure proximal gutter seal in the contralateral gate. Via the ipsilateral limb, the device can then be extended with a flared iliac extension and/or additional bifurcated device to obtain seal in the distal aorta (previous open repair) or common iliac arteries. Results Eight patients (male??, mean 78爕ears of age) were treated in this manner since January 2015. All patients underwent repair using Gore C3 device with 3 ( n ??) or 4 ( n ??) renovisceral branches. The celiac artery was sacrificed in 4 patients and 1 renal artery in 1 patient. Mean fluoroscopy time was 88.7爉in with a mean of 92.3燾c contrast utilized. Median length of stay was 7燿ays with 3燿ays spent in the intensive care unit. No major cardiac, respiratory, renal, neurologic, or wound complications occurred. Three patients had early endoleaks treated with additional endovascular techniques ( n ??) or open surgical ligation ( n ??) during the index hospitalization. Two late endoleaks were identified; 1 type II with stable sac size and 1 type III requiring iliac limb relining. All limbs and branches remain patent at the time of the last imaging study (mean 6.8爉onths). Conclusions We present an endovascular technique for repair of type III and IV TAAAs which appears to be both feasible and safe with good short-term outcomes.