The loop technique: Addressing celiac artery dissection in a branched and fenestrated endograft for the treatment of a type III thoracoabdominal aneurysm

Young Erben, Gustavo Oderich, Peter Gloviczki

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To describe a bailout technique for use during branched/fenestrated thoracoabdominal aortic aneurysm (TAAA) repair to address celiac artery (CA) dissection. Technique: The technique is demonstrated in a 69-year-old man who underwent fenestrated stent-graft repair of a 6-cm type III TAAA. The main fenestrated stent-graft was positioned without difficulty, and the renal and superior mesenteric arteries were stented. A stent-graft was placed in the CA, but angiography showed the vessel to be occluded by dissection beyond the stent-graft. Wire manipulations to regain access to the true lumen culminated in perforation. At this point, the gastroduodenal artery was catheterized with a 0.035-inch guidewire, which was advanced in retrograde fashion into the CA true lumen and then snared back to the left brachial artery forming a loop. After exchange for a 0.014-inch system, self-expanding stents were deployed into the hepatic artery. Postoperative recovery was uneventful, and the patient was discharged on day 6. At 1-year follow-up, the patient was doing very well. Imaging demonstrated no endoleak, no graft migration, and sac shrinkage to a diameter of 5.1 cm. Conclusion: The "loop technique" can be a very useful and effective bailout maneuver in regaining access to the true lumen of a dissected CA in patients undergoing branched/fenestrated thoracoabdominal aortic aneurysm repair.

Original languageEnglish (US)
Pages (from-to)614-617
Number of pages4
JournalJournal of Endovascular Therapy
Volume23
Issue number4
DOIs
StatePublished - Aug 1 2016

Fingerprint

Celiac Artery
Stents
Aneurysm
Dissection
Thoracic Aortic Aneurysm
Transplants
Endoleak
Therapeutics
Superior Mesenteric Artery
Brachial Artery
Hepatic Artery
Angiography
Arteries
Kidney

Keywords

  • Celiac artery
  • Dissection
  • Fenestrated stent-graft
  • Thoracoabdominal aortic aneurysm

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{52d87d83ffeb439cb63a9c8cdf8a6bfb,
title = "The loop technique: Addressing celiac artery dissection in a branched and fenestrated endograft for the treatment of a type III thoracoabdominal aneurysm",
abstract = "Purpose: To describe a bailout technique for use during branched/fenestrated thoracoabdominal aortic aneurysm (TAAA) repair to address celiac artery (CA) dissection. Technique: The technique is demonstrated in a 69-year-old man who underwent fenestrated stent-graft repair of a 6-cm type III TAAA. The main fenestrated stent-graft was positioned without difficulty, and the renal and superior mesenteric arteries were stented. A stent-graft was placed in the CA, but angiography showed the vessel to be occluded by dissection beyond the stent-graft. Wire manipulations to regain access to the true lumen culminated in perforation. At this point, the gastroduodenal artery was catheterized with a 0.035-inch guidewire, which was advanced in retrograde fashion into the CA true lumen and then snared back to the left brachial artery forming a loop. After exchange for a 0.014-inch system, self-expanding stents were deployed into the hepatic artery. Postoperative recovery was uneventful, and the patient was discharged on day 6. At 1-year follow-up, the patient was doing very well. Imaging demonstrated no endoleak, no graft migration, and sac shrinkage to a diameter of 5.1 cm. Conclusion: The {"}loop technique{"} can be a very useful and effective bailout maneuver in regaining access to the true lumen of a dissected CA in patients undergoing branched/fenestrated thoracoabdominal aortic aneurysm repair.",
keywords = "Celiac artery, Dissection, Fenestrated stent-graft, Thoracoabdominal aortic aneurysm",
author = "Young Erben and Gustavo Oderich and Peter Gloviczki",
year = "2016",
month = "8",
day = "1",
doi = "10.1177/1526602816649372",
language = "English (US)",
volume = "23",
pages = "614--617",
journal = "Journal of Endovascular Therapy",
issn = "1526-6028",
publisher = "International Society of Endovascular Specialists",
number = "4",

}

TY - JOUR

T1 - The loop technique

T2 - Addressing celiac artery dissection in a branched and fenestrated endograft for the treatment of a type III thoracoabdominal aneurysm

AU - Erben, Young

AU - Oderich, Gustavo

AU - Gloviczki, Peter

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Purpose: To describe a bailout technique for use during branched/fenestrated thoracoabdominal aortic aneurysm (TAAA) repair to address celiac artery (CA) dissection. Technique: The technique is demonstrated in a 69-year-old man who underwent fenestrated stent-graft repair of a 6-cm type III TAAA. The main fenestrated stent-graft was positioned without difficulty, and the renal and superior mesenteric arteries were stented. A stent-graft was placed in the CA, but angiography showed the vessel to be occluded by dissection beyond the stent-graft. Wire manipulations to regain access to the true lumen culminated in perforation. At this point, the gastroduodenal artery was catheterized with a 0.035-inch guidewire, which was advanced in retrograde fashion into the CA true lumen and then snared back to the left brachial artery forming a loop. After exchange for a 0.014-inch system, self-expanding stents were deployed into the hepatic artery. Postoperative recovery was uneventful, and the patient was discharged on day 6. At 1-year follow-up, the patient was doing very well. Imaging demonstrated no endoleak, no graft migration, and sac shrinkage to a diameter of 5.1 cm. Conclusion: The "loop technique" can be a very useful and effective bailout maneuver in regaining access to the true lumen of a dissected CA in patients undergoing branched/fenestrated thoracoabdominal aortic aneurysm repair.

AB - Purpose: To describe a bailout technique for use during branched/fenestrated thoracoabdominal aortic aneurysm (TAAA) repair to address celiac artery (CA) dissection. Technique: The technique is demonstrated in a 69-year-old man who underwent fenestrated stent-graft repair of a 6-cm type III TAAA. The main fenestrated stent-graft was positioned without difficulty, and the renal and superior mesenteric arteries were stented. A stent-graft was placed in the CA, but angiography showed the vessel to be occluded by dissection beyond the stent-graft. Wire manipulations to regain access to the true lumen culminated in perforation. At this point, the gastroduodenal artery was catheterized with a 0.035-inch guidewire, which was advanced in retrograde fashion into the CA true lumen and then snared back to the left brachial artery forming a loop. After exchange for a 0.014-inch system, self-expanding stents were deployed into the hepatic artery. Postoperative recovery was uneventful, and the patient was discharged on day 6. At 1-year follow-up, the patient was doing very well. Imaging demonstrated no endoleak, no graft migration, and sac shrinkage to a diameter of 5.1 cm. Conclusion: The "loop technique" can be a very useful and effective bailout maneuver in regaining access to the true lumen of a dissected CA in patients undergoing branched/fenestrated thoracoabdominal aortic aneurysm repair.

KW - Celiac artery

KW - Dissection

KW - Fenestrated stent-graft

KW - Thoracoabdominal aortic aneurysm

UR - http://www.scopus.com/inward/record.url?scp=84979587232&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979587232&partnerID=8YFLogxK

U2 - 10.1177/1526602816649372

DO - 10.1177/1526602816649372

M3 - Article

C2 - 27189928

AN - SCOPUS:84979587232

VL - 23

SP - 614

EP - 617

JO - Journal of Endovascular Therapy

JF - Journal of Endovascular Therapy

SN - 1526-6028

IS - 4

ER -