Single superior mesenteric artery periscope grafts to facilitate urgent endovascular repair of acute thoracoabdominal aortic pathology

Abstract

Purpose: To assess the use of periscope grafts to the superior mesenteric artery (SMA) in extending the distal sealing zone of thoracic stent-grafts.

Case reports: Three patients with ruptured Crawford type I thoracoabdominal aortic aneurysms (TAAA) and 1 patient with a symptomatic type B dissection underwent endovascular repair; the celiac trunk was intraoperatively occluded in all patients. The thoracic stent-graft was extended to immediately above the most cranial renal artery, and the SMA was simultaneously stented from a femoral approach (periscope graft). All 4 periscope grafts were successfully implanted. One patient with rTAAA and intraoperative hemodynamic instability died in the perioperative period with a patent SMA. The other 3 patients had patent SMA periscope grafts and were free from abdominal symptoms at 14, 12, and 7 months; follow-up CT scans showed excluded aneurysms in the 2 TAAAs. The patient with type B dissection became asymptomatic but had persistent retrograde perfusion and expansion of the false lumen.

Conclusion: Periscope grafts are a viable option for urgent endovascular repair of acute Crawford type I TAAA. In type B dissections, however, they are at most a bridging solution until more definitive exclusion of the false lumen is achieved.