Preliminary results with the use of the new bifurcated device in the endovascular treatment of abdominal and thoracoabdominal aneurysms
- V Costache, E Ciobanu, S Sultan, F. Nicolae
- J Cardiovasc Surg
Threemonths before presentation to our care, a 28-year-old woman, who was a heavy smoker but otherwise healthy, presented to another hospital emergency department with sudden-onset severe chest pain and dyspnea. Cardiovascular examination elicited a soft systolic ejection murmur and elevated D-dimers, but examinations were otherwise unremarkable. A computed tomography (CT) angiography, performed to investigate pulmonary embolism instead demonstrated acute type A aortic dissection. The patient underwent emergency open aortic root replacement with 28-mm Dacron graft (DuPont, Wilmington, Del), sparing her trileaflet aortic valve. She had no features to suggest Marfan or related syndromes. Initially, she recovered and was discharged on b-blocker medication but experienced persistent pain in her thoracic spine and left leg paresthesia with progressively worsening claudication. On presentation to our care, her left ankle-brachial index was 0.43, duplex ultrasound imaging demonstrated left common iliac artery thrombosis with a 90% to 99% flow-limiting stenosis, and a CT angiogram exhibited type B aortic dissection extending to the iliac arteries. The false lumen was compressing the true lumen, with false lumen index of 1.26. The patient was placed under general anesthesia, and both common femoral arterieswere cannulated.Apigtail catheterwas gentlymanipulated through the compressed true lumen to the Dacron tube in the ascending arch. The first Streamliner Multilayer Flow Modulator (MFM; CTMS 25200; Cardiatis, Ines, Belgium) was deployed from the descending thoracic aorta to the aortoiliac bifurcation. The second Streamliner MFM(CTMS25120)wasdeployed at the level of the left commoncarotid artery with a 10-cm overlap at the level of the visceral branches. TwoGenesis 1079-mm stents (Cordis Endovascular, Bridgewater, NJ) were hugged and deployed simultaneously at the distal part of the Streamliner MFM to the middle common iliac arteries bilaterally, thus creating in situ construction of a modular phantom-like device.