Use of the Octopus Endograft Technique to Reconstruct Renovisceral Arteries Arising From the False Lumen of a Rapidly Expanding Type B Aortic Dissection After Endovascular Repair. (February 2017)

• Record Type: Journal Article
• Authors: Xiong, Jiang; Ge, Yangyang; Liu, Xiaoping; Wang, Lijun; Guo, Wei
• Is Part Of: Journal of endovascular therapy. Volume 24:Number 1(2017:Feb.)
• Page Start: 107
• Page End: 111
• Publication Date: 2017-02
• Subjects: endograft -- false lumen -- octopus graft -- parallel grafts -- renovisceral arteries -- stent-graft -- stent-graft–induced new tear -- type B aortic dissection -- thoracoabdominal dissection -- thoracic endovascular aortic repair; Blood-vessels -- Endoscopic surgery -- Periodicals; Angioscopy -- Periodicals; Intravenous catheterization -- Periodicals; Peripheral vascular diseases -- Treatment -- Periodicals; Vascular Surgical Procedures -- Periodicals; Angioscopy -- Periodicals; Catheterization, Peripheral -- Periodicals; Peripheral Vascular Diseases -- therapy -- Periodicals; Angioscopie; Maladies vasculaires périphériques; 617.413
• DOI: 10.1177/1526602816678993
• Languages: English
• ISSNs: 1526-6028

Abstract

Purpose: To describe the use and 6-month outcomes of the octopus endograft technique to reconstruct renovisceral arteries arising from the false lumen (FL) of a type B aortic dissection after thoracic endovascular aortic repair (TEVAR).Case Report: A 46-year-old man post TEVAR for type B aortic dissection was admitted with persistent back pain and a rapidly expanding residual dissection. The celiac and left renal arteries arose from the FL and the superior mesenteric artery from both lumens, with the FL as its main supply. A 20% oversized Endurant stent-graft was deployed with the short limb just above the beginning of the dissection flap and the long limb in the aortic true lumen. A 120-mm-long Endurant extended limb was delivered antegradely via a conduit and deployed into the FL, with a 3-cm overlap with the short limb of the Endurant main body. The 3 renovisceral arteries were reconstructed by lining each with a series of Viabahn or Fluency stent-grafts whose proximal ends were subsequently placed parallel in the FL Endurant extended limb and dilated with kissing balloons. Imaging at 6 months showed an excluded FL, without stenosis or occlusion in the stent-graft or the renovisceral arteries.Conclusion: This case illustrates the successful use of the octopus endograft technique to reconstruct renovisceral arteries arising from a rapidly expanding FL in a post-TEVAR type B aortic dissection; the technique might be applicable in carefully selected patients.