Staged Repair of Residual "Mega" Type 3 Thoracoabdominal Aortic Aneurysm with Open Repair/Distal Infrarenal Elephant Trunk, Infrarenal EVAR/Iliac Branch Device
Christopher J. Smolock, MD, F Ezequiel Parodi, MD, Edward Soltesz, MD.
The Cleveland Clinic, Cleveland, OH, USA.
Objectives: To describe the planning as well as technical challenges of a multistage, multimodal repair of resultant mega-aneurysms of a chronic type B aortic dissection.Methods: This 59yo male presented with a 12cm type 3 TAAA, 5cm SMA aneurysm, 4cm common and internal iliac artery aneurysms after being lost to follow up for 7 years following TEVAR for type B dissection.Results: The patient fully recovered from 3 operations in a staged fashion over 4 months time to treat all aneurysms. First an open TAAA repair was performed using a multi-branched graft with distal, infrarenal elephant trunk placement. Next, into this elephant trunk and with adjunct left brachial artery access, an EVAR with left iliac branch device and right hypogastric artery coil embolization was utilized to complete the aortic repair. Finally, the SMA aneurysm was repaired with retrograde endograft placement, patch angioplasty, and false lumen embolization. The SMA aneurysm had increased to 7cm over this 4 month period but the patient remained asymptomatic.Conclusions: Extensive mega-aneurysms may be safely repaired in a multistage, multimodal fashion to employ the advantages of a variety of approaches, endovascular, open and hybrid, while modifying overall risk.
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