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 Scopus citations

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

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Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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