Partial subclavian artery coverage in TEVAR patients for acute type B aortic dissections: an alternative solution

TEVAR and periscope graft technique to treatment of huge aneurysm of aortic isthmus: Case report

Introduction

Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms. Innovative techniques as chimney and periscope grafts can improve the outcomes of procedure. Herein, we report a case in emergency of huge Thoracic aortic aneurism.

Presentation of case

An 86-year-old male with hypertension, diabetes mellitus, was referred to our hospital for chest pain. CT-angiography showed a huge aneurysm of aortic isthmus with signs of rupture. The patient was considered unfit for open surgery and an endovascular approach was chosen. This patient underwent endovascular repair with TEVAR, using the periscope graft technique to preserve patency in left subclavian artery (LSA).

Discussion

Symptomatic ischemia from LSA coverage has been reported to occur in only a modest 6–10% of patients and is often sacrificed with impunity given coverage rates between 10 and 50%. In this case reported the lack of revascularization of LSA increased the risk of neurological manifestations or stroke. Periscope technique is feasible and safe to maintain perfusion to the subclavian artery, with a 93% primary patency at 2 years.

Conclusions

Our experience using TEVAR with periscope graft technique as solution to address thoracic aneurysm of aortic isthmus was feasible and safe.

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Innovative techniques as chimney and periscope grafts can improve the outcomes of TEVAR.

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Subclavian Artery is important to vascularization of upper arm, vertebro-basilar circulation and medullar vascularization.

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Maintenance of blood flow to the LSA is recommended because it has been shown to prevent paraplegia in TEVAR procedures.

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Periscope technique is feasible and safe to maintain perfusion to the subclavian artery.