Percutaneous thoracic aortic aneurysm repair through transcaval aortic access

Abstract

Transcaval aortic access has been used for deployment of transcatheter aortic valves in patients in whom conventional arterial approaches are not feasible. This access can be vital in other situation when large bore access is needed. We described a case of 65-year-old man who had large thoracic descending aortic aneurysm with diffuse bilateral iliac disease precluding the arterial access required for the procedure. The patient underwent successful transcaval access with placement of 22-Fr balloon expandable sheath followed with successful deployments of 32 mm × 32 mm × 150 mm Valiant stent graft (Medtronic, Minneapolis, MN). The aorto-vena cava tract was closed successfully using 12 × 10 PDA occluder device with no residual flow at the end of the case, which was confirmed on repeated CT next day.

Transcaval Access to the Abdominal Aorta: indications of Interest to Surgeons and a Comprehensive Literature Review

“…In addition, references related to this subject but very narrative and repetitive were removed. Finally, 25 reports were selected: three on the access route technique [ 6 - 8 ] , one experimental study [ 9 ] ; three cohort references (one retrospective and two prospective) for TAVI [ 10 - 12 ] ; two cases on TC access for TAVI through a conventional aortic graft [ 13 , 14 ] ; one case on TC access for TAVI through partially thrombosed infrarenal aortic aneurysm [ 15 ] ; one case on TC access for TAVI in a patient with duplicated inferior vena cava [ 16 ] ; one case on TC access for Biventricular Impella placement [ 17 ] ; eight references on six cohorts (retrospective) on the treatment of type II endoleaks after EVAR [ 18 - 25 ] ; two cases on treatment of type I endoleaks after EVAR and after chimney endovascular aneurysm repair (ChEVAR) respectively [ 26 , 27 ] ; two cases on thoracic endovascular aneurysms repair (TEVAR) [ 28 , 29 ] ; and one systematic review on the transcaval access to the aorta [ 30 ] .…”

“…In addition to embolization of type II endoleaks [ 18 - 25 ] , the treatment of type I endoleaks [ 26 , 27 ] was developed in 2015. In 2015 and 2017, two cases of TC access for thoracic endovascular aortic repair (TEVAR) [ 28 , 29 ] were published. The aim of this review is to describe the current status of these indications and some technical details.…”

“…Two years later, Fanari et al [ 29 ] performed a procedure with similar technique and results ( Table 4 ). However, the patient developed a small type IA endoleak, which resolved spontaneously within a week.…”

Transcaval approach for endovascular aortic interventions: A systematic review

“…Of the 10 studies, there were 6 retrospective cohort studies [30,31,[37][38][39][40] evaluating transcaval endoleak repair, 2 studies (1 retrospective cohort [20]; 1 prospective cohort [21]) evaluating transcaval TAVI, and 2 case reports [32,41] evaluating TEVAR. Both case reports on TEVAR were not included in any pooled analysis, and instead reviewed only qualitatively in its entirety.…”

“…There were two case reports [32,41] that reported a transcaval approach for TEVAR. Since both are case reports, we did not perform any pooled analysis, and a narrative description follows.…”