Complete Transfemoral Endovascular Repair with Homemade Steerable Sheath of Intercostal Artery Patch Aneurysm after Open Repair of Thoracoabdominal Aortic Aneurysm

Published:March 04, 2022DOI:
      The aim of this paper is to describe a case of complete transfemoral approach for endovascular treatment of a large intercostal patch aneurysm with custom-made stent-graft in a patient with Loeys-Dietz syndrome and previous multiple aortic operations.
      Three aortic components were used to exclude a 65-mm intercostal patch aneurysm. Because of the reimplantation site of supra-aortic trunks in a previous open arch repair, we used a complete transfemoral approach with a homemade steerable sheath to deliver all the renovisceral bridging stents through the downward side-branches. No major complications were registered. A 6-month follow-up resulted uneventfully, and an initial shrinkage of the aneurysmal lesion was found.
      The use of a homemade steerable sheath was safe and effective for catheterization and stenting of all the target vessels through the downward side branches.
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        • Aalberts J.J.
        • van den Berg M.P.
        • Bergman J.E.
        • et al.
        The many faces of aggressive aortic pathology: Loeys-Dietz syndrome.
        Neth Heart J. 2008; 16: 299-304
        • Crawford E.S.
        • Snyder D.M.
        • Cho G.C.
        • et al.
        Progress in treatment of thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries.
        Ann Surg. 1978; 188: 404-422
        • Adam D.J.
        • Berce M.
        • Hartley D.E.
        • et al.
        Repair of recurrent visceral aortic patch aneurysm after thoracoabdominal aortic aneurysm repair with a branched endovascular stent graft.
        J Vasc Surg. 2007; 45: 183-185
        • Bertoglio L.
        • Mascia D.
        • Cambiaghi T.
        • et al.
        Management of visceral aortic patch aneurysms after thoracoabdominal repair with open, hybrid, or endovascular approach.
        J Vasc Surg. 2018; 67: 1360-1371
        • Loeys B.L.
        • Chen J.
        • Neptune E.R.
        • et al.
        A syndrome of altered cardiovascular, craniofacial, neurocognitive and skeletal development caused by mutations in TGFBR1 or TGFBR2.
        Nat Genet. 2005; 37: 275-281
        • Loeys B.L.
        • Schwarze U.
        • Holm T.
        • et al.
        Aneurysm syndromes caused by mutations in the TGF-beta receptor.
        N Engl J Med. 2006; 355: 788-798
        • Williams J.A.
        • Loeys B.L.
        • Nwakanma L.U.
        • et al.
        Early surgical experience with Loeys-Dietz: a new syndrome of aggressive thoracic aortic aneurysm disease.
        Ann Thorac Surg. 2007; 83: S757-S790
        • Safi H.J.
        • Miller 3rd, C.C.
        • Carr C.
        • et al.
        Importance of intercostal artery reattachment during thoracoabdominal aortic aneurysm repair.
        J Vasc Surg. 1998; 27: 58-68
        • Tenorio E.R.
        • Tallarita T.
        • Mirza A.K.
        • et al.
        Endovascular repair of large intercostal artery patch aneurysm using branch stent-graft in a patient with Loeys-Dietz syndrome.
        J Thorac Cardiovasc Surg. 2020; 159: e95-e99
        • Etz C.D.
        • Debus E.S.
        • Mohr F.-W.
        • et al.
        First-in-man endovascular preconditioning of the paraspinal collateral network by segmental artery coil embolization to prevent ischemic spinal cord injury.
        J Thorac Cardiovasc Surg. 2015; 149: 1074-1079
        • Griepp R.B.
        • Griepp E.B.
        Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept.
        Ann Thorac Surg. 2007; 83 (discussion S890–2): S865-S869
        • Ferrer C.
        • Venturini L.
        • Grande R.
        • et al.
        A steerable sheath to deploy hypogastric bridging stent by contralateral femoral approach in an iliac branch procedure after endovascular aneurysm repair.
        Ann Vasc Surg. 2017; 44: 415.e1-415.e5
        • Panuccio G.
        • Rohlffs F.
        • Makaloski V.
        • et al.
        Through-and-through suture technique to stabilize a sheath in branched endovascular aortic repair.
        J Endovasc Ther. 2019; 26: 805-809
        • Simonte G.
        • Fino G.
        • Isernia G.
        • et al.
        Forced complete femoral approach for urgent thoracoabdominal aneurysm repair using an inner branched endograft.
        Ann Vasc Surg. 2020; 64 (412.e7–412.e13)
        • Orrico M.
        • Ronchey S.
        • Setacci C.
        • et al.
        The "Destino-guided BEVAR" to catheterize downward branches from a femoral access: technical note and case report.
        Ann Vasc Surg. 2019; 57: 266-271
        • Gallitto E.
        • Faggioli G.
        • Bertoglio L.
        • et al.
        Steerable sheath for cannulation and bridging stenting of challenging target visceral vessels in fenestrated and branched endografting.
        Ann Vasc Surg. 2020; 67: 26-34
        • Mallios A.
        • Yankovic W.
        • Boura B.
        • et al.
        Three new techniques for creation of a steerable sheath, a 4F snare, and bidirectional sheath inversion using existing endovascular materials.
        J Vasc Surg. 2012; 56 (853–60.e603)