Uncommon indication for an Octopus technique in a symptomatic infected thoracoabdominal aneurysm after thoracic endoprosthesis

Abstract

Emergent thoraco-abdominal aneurysms (TAAA) repair remains challenging. Endovascular treatment should be considered in patients unfit for open surgery. Octopus technique is an off-the-shelf solution suitable for selected situations. We describe the successful treatment of a symptomatic and infected TAAA. A 66-year-old man presented to the emergency department with an infected 92mm TAAA with impending rupture due to Type 1b endoleak following previous TEVAR. 18FDG-PET-CT ruled out an endograft infection but diagnosed an aortitis.. Considering the emergent setting and his comorbidities, the patient was treated with the Octopus technique. Both renals were sacrificed and the celiac trunk was previously occluded, leaving the superior mesenteric artery the only target vessel. Treatment was successful and patient went home with a lifelong oral antibiotherapy. The 6-months angio-CT confirmed the absence of endoleak and patent superior mesenteric artery. The Octopus procedure can be used in selected cases for urgent endovascular TAAA repair in patients who are unfit for open repair.