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William J. Quiñones-Baldrich, MD, Thomas F. Panetta, MD, Candace L

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Presentation on theme: "William J. Quiñones-Baldrich, MD, Thomas F. Panetta, MD, Candace L"— Presentation transcript:

1 Repair of type IV thoracoabdominal aneurysm with a combined endovascular and surgical approach 
William J. Quiñones-Baldrich, MD, Thomas F. Panetta, MD, Candace L. Vescera, RN, Vikram S. Kashyap, MD  Journal of Vascular Surgery  Volume 30, Issue 3, Pages (September 1999) DOI: /S (99) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2 Fig. 1 Preoperative computed tomography scan revealing an aneurysmal visceral aorta and superior mesenteric artery. The superior mesenteric artery aneurysm extended distally 5 cm from its origin. Journal of Vascular Surgery  , DOI: ( /S (99) ) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3 Fig. 2 Preoperative antero-posterior angiogram revealing the thoracoabdominal aneurysm, starting in the distal thoracic aorta and involving the visceral aorta. Journal of Vascular Surgery  , DOI: ( /S (99) ) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

4 Fig. 3 Preoperative lateral angiogram showing a celiac artery aneurysm measuring 2 cm and superior mesenteric artery aneurysm measuring 2.2 cm. Journal of Vascular Surgery  , DOI: ( /S (99) ) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

5 Fig. 4 The Corvita endovascular graft deployed in the thoracic aorta. Another Corvita graft was deployed in the abdominal aorta, with overlapping of the two grafts in the midportion. This completely excluded the thoracoabdominal aneurysm, with no evidence of perigraft leak. Journal of Vascular Surgery  , DOI: ( /S (99) ) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

6 Fig. 5 Retrograde visceral bypass grafts. A bifurcated Dacron graft was used for bilateral renal artery bypass grafting, with the right iliac limb (of a previous aortic graft) serving as the donor vessel. Another Dacron tube graft was sewn on to the hood of the bifurcated graft. This was brought along the leaves of the base of the mesentery for anastomosis with the superior mesenteric artery at the level of the middle colic artery (side-to-side) and to the celiac axis (end-to-side) sequentially. Journal of Vascular Surgery  , DOI: ( /S (99) ) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

7 Fig. 6 Postoperative computed tomography scan at 3 months, revealing a well-seated endovascular graft without any perigraft leak, diminishing aneurysm sac size, and good perfusion of the viscera. Journal of Vascular Surgery  , DOI: ( /S (99) ) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

8 Fig. 7 Spiral computed tomography scan 6 months after a combined endovascular and surgical approach of a type IV thoracoabdominal aneurysm was performed. All visceral bypass grafts are patent, with complete exclusion of the aneurysm. Journal of Vascular Surgery  , DOI: ( /S (99) ) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

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