Antegrade thoracic endovascular aortic repair via the left axillary artery in a patient with aortoiliac occlusive disease (Leriche syndrome)

Abstract

We present the case of a 77-year-old man with a saccular descending thoracic aortic aneurysm who underwent successful antegrade thoracic endovascular aortic repair (TEVAR) via the left axillary artery. The patient had a history of axillo-bifemoral bypass grafting due to aortoiliac occlusive disease (Leriche syndrome), which precluded normal retrograde TEVAR. Upon successful procedure completion, no endoleak was noted on postoperative computed tomography. The patient was discharged from the hospital without any complications. The left axillary artery is useful as an alternative access site in cases wherein conventional retrograde TEVAR is not feasible.

Manejo endovascular de hemoptisis secundaria a pseudoaneurisma de la aorta torácica, mediante un abordaje proximal.

“…Esta imagen puede revelar, además del propio pseudoaneurisma, hematoma periaórtico, trombo mural y extravasación de contraste al parénquima pulmonar. Adicionalmente, permite evaluar con precisión el diámetro, la tortuosidad y el grado de calcificación del vaso de acceso 8 . Cuando se sospecha FAB, la broncoscopia debe usarse con precaución, particularmente cuando hay hemoptisis abundante; el endoscopio puede provocar la movilización de trombos en la fístula, lo que puede provocar una hemorragia masiva 9 .…”

Trans-carotid endovascular repair of ascending aortic pseudoaneurysms

“…Although we did not use neurocerebral monitoring such as EEG, motor evoked potentials, and somatosensory evoked potentials, these can be utilized for intraoperative monitoring and may help identify a stroke expeditiously . Subclavian artery approaches have been reported as well and success with subclavian TAVR have encouraged surgeons to use the subclavian artery for deployment in select patients . However, deployment via the carotid artery may confer an advantage as the delivery system is relatively coaxial with the ascending aorta compared to the subclavian artery.…”

“…8 Subclavian artery approaches have been reported as well and success with subclavian TAVR have encouraged surgeons to use the subclavian artery for deployment in select patients. 9,10 However, deployment via the carotid artery may confer an advantage as the delivery system is relatively coaxial with the ascending aorta compared to the subclavian artery. The addition of a mechanical aortic valve, which was present in this case, also poses a unique challenge.…”