Repair of Ruptured Thoracoabdominal Aortic Aneurysm with Physician Modified Endograft

James Middleton Chang, MD

Yazan Duwayri, MD

Georgia Vascular Society, 7th Annual Scientific Sessions

September 7th, 2019 – Greensboro, Georgia

Division of Vascular Surgery

Disclosures

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No financial conflicts of interest

This presentation includes the off-label use of an

FDA approved product

Presentation

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70 Female

Incidentally identified thoracoabdominal aneurysm

up to 6.2cm.

PMH: HTN, HLD, Lumbar spinal stenosis

PSH: Appendectomy, BSO, Csection, right

hemicolectomy

Plan: Preoperative Testing and Open Repair

Pre-operative Imaging

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Re-Presentation

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Prior to repair, patient presented to an outside institution

with abdominal pain.

Hemodynamically stable

CT: contained rupture

Transferred to Emory for further management.

Re-Presentation

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Re-Presentation

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Admitted for repair

Initial management with intensive blood pressure

control

Planned for endovascular repair

Proceeded to OR for physician modified

endograft placement with fenestrations for the

celiac, SMA, and both renal arteries using Cook®

Zenith Alpha™ platform

Device Modification

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Pre-operative CT

examined carefully and

fenestrations planned

Cook Alpha deployed on

back table

Planned fenestrations

created with eye cautery,

reinforced with snare

Device Modification

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Diameter reducing ties

placed with chromic

sutures

Device reconstrained and

placed into 22 French

peel-away sheath

Operative Details

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Post-operative Course

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Post-operative Course

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Did well post-operatively

Started on Plavix

Discharged home on POD#4

Patient continues to do well 8 months post-repair, US

performed at 1 month demonstrating patent stents

Conclusion

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Fenestrated repair of patients with

thoracoabdominal aneurysm rupture provides a

viable alternative to open repair in select patients

Surgeon modified endografts can be used for

certain anatomic and physiologic aortic

pathologies

Limited availability of branched technology

creates a need for creative/advanced endovascular

techniques

Conclusion