Complex multi stage thoracoabdominal aneurysm correction. Branched endograft with forced femoral access and flap perforation

acute type B aortic dissection with thoracic aortic aneurysm. no proximal sealing zone for TEVAR landing and dilated ascending aorta.

-Car-car-sub by pass
-Ascending aortic replacement, ascending to innominate by pass and TEVAR

@ control CTA fast aneurysm enlargement

4 inner branches (two antegrade and two retrograde) custom made endograft.
access to RRA through hole performed in the lamella
forced femoral access (no arch vessel available) with steerable sheat


    Dr. Theodosios Bisdas
    April 15, 2019

    nice case Gioele and congrats. Just a short question: Which sheath was that (Oscor or Fustar)?

    Dr Gioele Simonte
    April 18, 2019

    thanks for the comment, actually the steerable sheats used were two different Oscor .
    We had to use two devices since once deployed the SMA bridging stent the radius curve of the sheat we used (7 fr) turned out to be too sharp for the advancement of the CT bridging stent as we were not able to push it over the sheat curve. we had than to pick up a 10 fr with a wider curve easily resolving the problem.
    no experience with the Fustar in my facility

    Vladimir Baron
    July 5, 2019

    Great case Dr Simonte, congratulations. Two questions: what device did you use to fenestrate the septum? Did you use IVUS to choose the place to fenestrate? Thanks

    Dr Gioele Simonte
    July 8, 2019

    Thanks for asking.
    to fenestrate the septum we used the stiff back end of a standard Terumo wire, into a bended steerable sheat in order to ensure a perpendicular incidence angle.
    We did not feel necessary to use IVUS since with fusion image guidance we could easily identify the right projection and the right point to perform the fenestration

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