Directional Atherectomy of the Common Femoral Artery. Learning Curve and One Year Follow up

Abstract

cardiac surgery team and subsequently perform a carotidleft subclavian bypass and TEVAR with the placement of a bare metal thoracic aortic stent (PETTICOAT technique) to maximize endograft expansion and preserve spinal cord perfusion. The procedure was carried out after the placement of a cerebrospinal fluid drainage. Results: The final intra-operative angiogram showed an adequate re-expansion of the true lumen and of the endograft; however, an endoleak from the distal portion of the left renal artery was still perfusing the false lumen. We tried to cannulate the left renal artery in order to exclude the endoleak with an overlapping covered stent, without achieving technical success. The patient recovery was also complicated by a left subclavian-jugular deep vein thrombosis that required anticoagulant therapy. After six days post-operatively, the patient developed paraplegia and neurological bladder. An MRI scan detected an epidural hematoma causing spinal cord's compression. An urgent surgical evacuation of the hematoma was performed by the Neurosurgeon team and the patient began a rehabilitation program. Six months after the operation, the patient is in good general conditions and completely recovering from his neurological impairment. Conclusion: Aortic dissection is an uncommon complication after fEVAR. Few cases have been described in literature. This condition may have been caused by a iatrogenic intimal lesion of the aorta due to manipulation with guidewires, an endograft-related damage of the aortic wall, an arterial wall disease or a combination of multiple causes.