Cardiothoracic Surgery
General Vascular Surgery
Haley Lehman, DO
Resident Physician
Henry Ford Health
Disclosure(s): No financial relationships to disclose
A transcaval crossing point was chosen at the closest distance between the IVC and the aorta at L3-L4. An Astato wire inside of a cook 2x30 balloon inside of a 0.035 CXI catheter was utilized for transcaval crossing. Astato wire was connected to bovie using 50 watts. The electrocauterized wire was passed from the IVC into the aorta and snared using a 20 mm gooseneck snare that was passed into the aorta from the left groin (Figure d). 2.0 cook balloon was inflated to facilitate the passage of the CXI catheter across the newly created fistula. A Lunderquist wire was then passed through the cavoaortiic tract into the proximal descending aorta. 24-french GORE DrySeal sheath was passed without difficulty from the left femoral vein into the aorta (Figure e).
At this time a lunderquist wire was passed into the aorta from the right groin access site. A pigtail catheter was passed through the left groin access to the junction between the ascending aorta and aortic arch. An aortogram was preformed identifying all arch vessels. A 38x38x200 Medtronic © Valiant Captivia thoracic graft was passed through the right groin access into the aorta. It was deployed just distal to the left subclavian artery (Figure f). A 38x38x150 Medtronic © Valiant Captivia thoracic graft was deployed as an extension which covered the distal descending aortic ulcer extending just proximal to the celiac trunk (Figure g). At this time balloon angioplasty of the stent was completed and completion aortogram demonstrated no evidence of endoleak.
Outcomes: Patient tolerated the procedure well and no endoleaks were visualized at the end of the case. Follow up CT demonstrated the thoracic graft in the appropriate location without evidence of migration, endoleak, or enlarged aneurysmal sac.
Conclusion: In patients with significant peripheral vascular disease, a transcaval TEVAR is a reasonable and safe approach to repairing a thoracic aortic aneurysm.