Chimney graft into the left subclavian artery during thoracic endograft placement(TEVAR)

An 88-year-old man with History of open abdominal surgery due to intestinal obstruction with large residual incisional hernia, was referred due to back and flank pain with the diagnosis of Crawford Type 1 TAAA starting at the LSA and extending to the renal arteries

As the LSA bypass was not feasible due to patient’s frailty and old age, we conducted single Chimney TEVAR using a V12 inserted from the Left brachial in subclavian artery, followed by TEVAR from the LCA to the celiac trunk. Due to a severe bend in the descending aorta, procedure was more complicated which was managed by an extra stent graft. The femoral access was managed by Perclose Proglide technique.