Endovascular treatment of thoracoabdominal aortic aneurysms

A, An anterior view of the cuff-bearing segment of the primary aortic stent graft. B, An internal view of the same stent graft. C, A Fluency (C. R. Bard, Inc, Tempe, Ariz) covered stent within a cuff of the primary aortic stent graft.

A, A computed tomography angiography (CTA) after multibranched repair of a type II thoracoabdominal aortic aneurysm shows the usual branches to the celiac, superior mesenteric, and renal arteries. B, CTA after left carotid-subclavian bypass and endovascular repair of a distal arch aneurysm, which was performed in conjunction with multibranched repair of the thoracoabdominal aorta. There is a covered stent within the left carotid artery to preserve flow while lengthening the proximal implantation site.

A, A preoperative computed tomography (CT) scan shows a right common iliac aneurysm, left common iliac stenosis, and bilateral iliac stenosis. B, A CT scan shows a (1) right common iliac to external iliac bypass, with (2) prograde flow to the common femoral artery and (3) retrograde flow through the external iliac artery to the (4) internal iliac artery. Two weeks later, this bypass graft was used as a route for stent graft insertion.

A, Intraoperative fluoroscopy shows (1) orientation markers, (4) a catheter within the superior mesenteric artery, and markers at the distal ends of cuffs for branches to the (2) celiac and (3) superior mesenteric arteries. B, Intraoperative fluoroscopy shows markers at the distal end of the (1) right renal cuff, the (2) tip of a 10F transbrachial sheath, (3) a tiny (0.014-in) brachial-femoral guidewire, and (4) coils in the smaller (3 mm) of the two renal arteries. C, Intraoperative angiography shows a branch of the stent graft to the larger (5 mm) of the two right renal arteries. D, Intraoperative fluoroscopy shows a (1) guidewire with its tip in the splenic artery, (2) markers at the outer end of the celiac cuff, (3) distal and (4) proximal ends of the undeployed Fluency (C. R. Bard, Inc, Tempe, Ariz) covered stent, and (5) a marker at the inner end of the celiac cuff.

Kaplan Meier plots of overall survival (diamonds) and freedom from aneurysm-related death (squares). The dotted line indicates a standard error >10%.

A preoperative computed tomography scan shows the aneurysm, stenosis, and angulation of the left renal artery and severe stenosis of the right renal artery.

A postoperative computed tomography scan shows a tortuous stent graft within a tortuous aorta.