PMC6599168_01
Schematic of patient's anatomy and proposed treatment strategy. (A) 60 mm TAA, 59 mm juxtarenal AAA, and 32 mm CIAA. (B) First treatment strategy. TEVAR plus chEVAR with bilateral renal artery chimneys and CIAA exclusion with preservation of the hypogastric artery applying the sandwich technique. (C) TEVAR plus chEVAR, with a chimney for the right renal artery and a periscope for the left renal artery with an additional aortic stent applied in the neck, and CIAA exclusion with preservation of the hypogastric artery applying the sandwich technique.
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TAA, 59 mm juxtarenal AAA, and 32 mm CIAA (Fig. 1, Video 1). Thoracic endovascular aortic repair (TEVAR) plus endovascular aortic repair (EVAR) with bilateral renal artery chimneys and CIAA exclusion with preservation of the hypogastric artery applying the sandwich technique was planned, with both renal artery and hypogastric artery selective catheterisation via an axillary approach (Fig. 1). The left renal artery was catheterised by a femoral approach, and, instead of bilateral renal artery chimney grafts, a chimney for the right renal artery and a periscope for the left renal artery with an additional aortic stent applied in the neck was performed (Fig. 1).
3D reconstruction of follow up CT scans. (A1 and A2) one year follow up. (B1 and B2) three year follow up. The TEVAR plus chEVAR can be seen with the periscope for the left renal artery, and right common iliac artery aneurysm exclusion with hypogastric artery preservation by the sandwich technique.
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For that reason, another CT scan was performed in April 2018 (Fig. 2 and Video 3), which revealed a small type 2 endoleak and sac growth from the original 59 mm to 67 mm.