Multi-component Parallel Endografts at Complex TEVAR May Be Prone to Modular Dislocation Causing Novel Endoleaks: A Tale of Two Cases

Abstract

Introduction: We report two cases of complex thoracic endovascular aneurysm repair (TEVAR) with endoleakage due to modular dislocation of multi-component left subclavian parallel endografts in periscope configuration. Report: First, a 67-year-old female patient presented with a 75-mm thoracic aortic aneurysm that was treated by right-to-left carotidecarotid bypass, and TEVAR with a two-piece left subclavian arterial periscope. This was complicated by modular disconnection of the periscope components and also proximal migration of the upper component of the periscope, resulting respectively in endoleaks due to modular disconnection and partial loss of seal. Second, a 65-year-old man presented with a chronic type B aortic dissection with combined true and false lumen diameter of 65 mm, treated by TEVAR and a three-piece left subclavian arterial periscope, which was complicated by modular dislocation of only the upper overlap. These were successfully treated by percutaneous endografting to bridge the disconnected segments, and to also achieve a seal in the left subclavian artery for the first patient. Discussion: These cases indicate multi-component parallel endografts at TEVAR may be prone to modular disconnection, possibly due to distracting forces contributed by the configuration of the main thoracic endograft in conjunction with flow haemodynamics. They also highlight the need for longer overlap zones for the stentgrafts used in chimneyeperiscopeesnorkel techniques and use of single long pieces whenever possible. We would also suggest review of the current endoleak classification in this context.

Morphological Analysis of Healthy Aortic Arch

“…First, the length of zones 1 and 2 gives information relative to the increase in landing zone distance that will be achieved by a debranching procedure or by parallel graft techniques. 17 The relatively shorter length of zone 1 partly explains the relatively higher incidence of type I endoleak observed by some authors in this landing zone. 18,19 It also supports the reluctance to deploy stent grafts in zone 1.…”

Thoracic aortic aneurysm: a late complication of coarctation repair

“…1 ). This was treated with a complex hybrid thoracic endovascular aneurysm repair [ 1 ].

Figure 1: Saggital and coronal views of the aneurysm.

…”

Evaluation of EndoAnchor Aortic Wall Penetration After Thoracic Endovascular Aortic Repair

“…Mid-and long-term results in large series demonstrate durability in anatomically suitable patients; however, reinterventions due to loss of proximal and distal seal compromise procedure success and stability. 2 Several endovascular techniques have been described to improve the length of seal in the proximal landing zone, such as use of chimneys and periscopes, 3,4 scallops, 5 fenestrations, 6,7 and branches. 8,9 In terms of arch and thoracic aortic anatomical parameters, angulation 10 and adequate seal zone length (>20 mm) and diameter (<40 mm) have been described as mandatory to achieve adequate seal in the proximal landing zone.…”