Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysm Using Total Percutaneous Transfemoral Approach

Abstract

Fenestrated and branched endovascular aortic repair has gained widespread acceptance as an alternative option to open surgical repair in patients with thoracoabdominal aortic aneurysms . Incorporation of the renal and mesenteric arteries is possible using fenestrations or directional branches, with either off the shelf or custom designs that are tailored to the patient anatomy. Fenestrations are ideally suited for target vessels that have origin in narrower aortic segments with transverse or upgoing orientation, whereas directional branches are preferentially selected to incorporate vessels with down-going orientation with origin in large aortic segments. Traditionally, directional branches are accessed via the upper extremity approach for placement of bridging stents into the target vessels. Recent developments in steerable sheath technology have allowed total transfemoral access, decreasing the risks of cerebrovascular emboli associated with manipulations across the aortic arch. We describe the technical pitfalls of Fenestrated and branched endovascular aortic repair of thoracoabdominal aortic aneurysms using total trans-femoral access.