Transluminal endovascular branched graft placement for a pseudoaneurysm: Reconstruction of the descending thoracic aorta including the celiac axis

Abstract

We I have previously reported a successful transluminal endovascular placement of a branched graft that had a sidearm extending into the left subclavian artery for repair of type B aortic dissection. The sidearm was properly positioned by catching and pulling back the free end of a detachable wire attached to its end by means of a gooseneck snare wire, which was percutaneously inserted through the left brachial artery. However, it is impossible to place sidearm grafts into the celiac axis and renal arteries in a similar manner. In this article, we describe a new method of inserting a sidearm into the celiac axis and report successful transluminal endovascular repair of a pseudoaneurysm with the use of the branched graft. A 73-year-old man with severe chronic renal failure requiring hemodialysis had previously undergone surgical repair of an aneurysm of the descending thoracic aorta. However, a pseudoaneurysm of the descending thoracic aorta resulting from dehiscence of the suture line at the proximal and distal anastomoses after composite graft surgery had continued to dilate, reaching 80 mm in diameter. Although surgical treatment was attempted, the effort was given up because of marked adhesions caused by a previous thoracotomy. He was admitted to our hospital for endovascular treatment of the pseudoaneurysm. The structure of the Inoue endovascular graft was previously described in detail. 2 The graft was constructed from a Dacron polyester fabric cylinder and the surface was supported by multiple rings of extra-flexible nickel titanium wire. The patient gave informed consent in conformance with the protocols approved by the institutional review board of Takeda Hospital. Endovascular grafting with the straight graft was performed on June 28, 1995. Although the proximal communication was completely obliterated after the procedure, the distal communication persisted because the distal orifice of the pseudoaneurysm was in close proximity to the celiac axis. Although transluminal embolization was