Snare-assisted thoracic endovascular aortic repair for redirection of a false lumen elephant trunk

Chen, Julia Fayanne; Mangi, Abeel A.; Vallabhajosyula, Prashanth; Nassiri, Naiem

doi:10.1016/j.jvscit.2020.08.008

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…To manage this complication nonemergently, the FL and TL should be bridged using existing or new trans-septal fenestrations. 5 Fenestrations can be created via a guidewire or an atraumatic radiofrequency wire and serially balloon dilated or using an Outback LTD re-entry catheter (Cordis, Johnson & Johnson, Bridgewater, NJ). 4 , 5 , 6 , 7 , 8 For more acute dissections, the thin flap architecture can be perforated or torn down using a micro-guidewire.…”

Section: Discussionmentioning

confidence: 99%

“… 5 Fenestrations can be created via a guidewire or an atraumatic radiofrequency wire and serially balloon dilated or using an Outback LTD re-entry catheter (Cordis, Johnson & Johnson, Bridgewater, NJ). 4 , 5 , 6 , 7 , 8 For more acute dissections, the thin flap architecture can be perforated or torn down using a micro-guidewire. 9 We used an existing fenestration proximal to the ET and the ascending aorta–femoral snare-assisted technique to bridge the first-stage TEVAR and the ET using a stent.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trans-sternotomy, snare-assisted thoracic endovascular aortic repair for redirection of a migrated elephant trunk

Fereydooni¹,

Amabile²,

Nassiri³

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trans-sternotomy, snare-assisted thoracic endovascular aortic repair for redirection of a migrated elephant trunk

Fereydooni¹,

Amabile²,

Nassiri³

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…In 2020, Chen et al reported that inadvertent placement of an elephant trunk into the FL was repaired by implantation of a stent graft using a right-brachial to femoral through-and-through wire approach. 9 A femoral guidewire was advanced from the TL into the FL via a preexistent intimal tear without necessity for fenestration. Snaring of the wire from an additional transbrachial access secured successful FL-TL redirection.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

et al. 2022

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Purpose: Unintended false-lumen thoracic endovascular aortic repair (TEVAR) is under-reported and often fatal. We present percutaneous endovascular rescue techniques for true-lumen reperfusion with strategies to address the peripheral artery perfusion needs unique to each case. Case Report: Two patients deteriorated 24 hours after uncomplicated and complicated acute aortic type-B dissection TEVAR treatment at a tertiary community hospital. Reevaluation of index and repeated imaging studies revealed inadvertent false-lumen TEVAR with severe visceral and peripheral ischemia. Stepwise subtraction angiography was used to confirm continuous true-lumen catheterization from femoral puncture into the thoracic aorta. Retrograde fenestration distal to the misplaced TEVAR from the true- into the false-lumen allowed for snorkeling by distal stent-extension across the dissection membrane. In one case, TEVAR stent graft extension resulted in true-lumen re-expansion and in the other case, bare-metal stent-extension for stabilization of the dissection membrane resulted in true-lumen re-expansion in addition to preservation of visceral and peripheral perfusion via the false-lumen. Despite excellent acute hemodynamic results and initial signs of recovery, both patients eventually died (multiorgan failure; cerebral hemorrhagic infarction). Conclusion: Correct indication and prompt recognition of potential inadvertent false-lumen stenting is critical to avoid disastrous sequelae, for example, malperfusion. Endovascular salvage is feasible for restoration of correct perfusion and must be performed in a timely manner. Clinical Impact Clinically apparent, complicated type-B dissection necessitates instantaneous treatment. Prerequisite for an endovascular approach is a true-lumen guidewire continuously from access to the ascending aorta. DSA after TEVAR and prompt clinical re-evaluation are to verify effective visceral and peripheral restoration of blood flow. Despite these measures, inadvertent false-lumen TEVAR may occur rarely. Immediate recognition may allow for timely true-lumen re-expansion using percutaneous endovascular salvage techniques e.g. retrograde fenestration from the true- into the false-lumen for distal snorkeling of the misplaced TEVAR across the dissection membrane. However, morbidity and mortality are very high, if erroneous stent graft placement is not identified early.

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Endovascular salvage of renal and common iliac artery malperfusion following inadvertent hybrid arch dissection stent deployment in the false lumen during repair of type A dissection

Pandya,

Dubois,

Scallan

2025

Journal of Vascular Surgery Cases, Innovations and Techniques

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Snare-assisted thoracic endovascular aortic repair for redirection of a false lumen elephant trunk

Cited by 3 publications

References 11 publications

Trans-sternotomy, snare-assisted thoracic endovascular aortic repair for redirection of a migrated elephant trunk

Trans-sternotomy, snare-assisted thoracic endovascular aortic repair for redirection of a migrated elephant trunk

Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

Endovascular salvage of renal and common iliac artery malperfusion following inadvertent hybrid arch dissection stent deployment in the false lumen during repair of type A dissection

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