Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;10(2):80-84.
doi: 10.1055/s-0042-1743200. Epub 2022 Aug 7.

Multiple Parallel Grafts for Urgent Endovascular Repair of a Ruptured Mycotic Aortic Aneurysm

Andrea Xodo  1 , Michele Piazza  1 , Jacopo Taglialavoro  1 , Marco Zavatta  1 , Franco Grego  1 , Michele Antonello  1
Affiliations

Multiple Parallel Grafts for Urgent Endovascular Repair of a Ruptured Mycotic Aortic Aneurysm

Andrea Xodo et al. Aorta (Stamford). 2022 Apr.

Abstract

A 73-year-old woman underwent urgent endovascular repair of a ruptured mycotic aortic aneurysm. A thoracic stent graft was employed as the main endograft, while the celiac trunk and superior mesenteric artery were revascularized by the chimney technique and the renal arteries through the periscope technique. Postoperative computed tomography revealed a Type A1 gutter, treated by detachable coils and peripheral occlusion devices. Six-month follow-up revealed patency of the stent grafts, without endoleak or stent graft infection signs.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest related to this article.

Figures

Fig. 1
Fig. 1
Visceral vessels and aortic diameters ( A , B ). Preoperative planning: “chimney” technique to ensure the celiac artery and the superior mesenteric artery revascularization, with “periscope” technique for both renal arteries revascularization; XY length was 10 cm ( C , D ).
Fig. 2
Fig. 2
Cannulation of the aortic branch vessels, with a 20-Fr sheath into the right common iliac artery ( A ). Both renal arteries were cannulated from the femoral accesses, while celiac artery (CA) and superior mesenteric artery (SMA) cannulations were achieved from the brachial accesses ( A , B ). Proximal and distal molding into the main endograft by an aortic compliant balloon, respectively, simultaneously with CA/SMA and renal intrastent ballooning ( C ). Red arrow shows Ruby detachable coils (32–60 mm) filling a periendograft large cavity. Green arrow indicates peripheral occlusion device (POD) (6 × 50–4 × 30 mm), which are characterized by presence of an anchor segment to fix the system in a high-flow space as the gutter, achieving a high packing density. Blue arrows show POD packing coils, a vascular closure system with an elongated shape designed to fill the spaces left empty by the POD system ( D ).
Fig. 3
Fig. 3
Arrows show the contrast enhancement outside the endograft at the computed tomography angiography (CTA) after the initial repair ( A – C ). Arrows indicate a good result, without signs of endoleak, in the control CTA 6 months after the procedure ( D – F ).
See this image and copyright information in PMC

References

    1. Dolapoglu A, de la Cruz K I, Coselli J S. Management of a mycotic thoracoabdominal aortic aneurysm involving the celiac artery. Tex Heart Inst J. 2016;43(06):528–530. - PMC - PubMed
    1. Mendes B C, Oderich G S. Endovascular repair of thoracoabdominal aortic aneurysm using the off-the-shelf multibranched t-Branch stent graft. J Vasc Surg. 2016;63(05):1394–139900. - PubMed
    1. Overeem S P, Boersen J T, Schuurmann R CL. Classification of gutter type in parallel stenting during endovascular aortic aneurysm repair. J Vasc Surg. 2017;66(02):594–599. - PubMed
    1. European MAA collaborators . Sörelius K, Mani K, Björck M. Endovascular treatment of mycotic aortic aneurysms: a European multicenter study. Circulation. 2014;130(24):2136–2142. - PubMed
    1. Dubois M, Daenens K, Houthoofd S, Peetermans W E, Fourneau I. Treatment of mycotic aneurysms with involvement of the abdominal aorta: single-centre experience in 44 consecutive cases. Eur J Vasc Endovasc Surg. 2010;40(04):450–456. - PubMed