Abdominal Aortic Access for Thoracic Endovascular Aortic Repair: A Safe and Effective Alternative in Challenging Vascular Anatomy

TL;DR

This paper presents a successful case of using an abdominal aortic approach for TEVAR when femoral access is not possible, showing it can be a safe alternative.

Contribution

The paper introduces the abdominal aortic approach as a novel solution for TEVAR in patients with challenging vascular anatomy.

Findings

The abdominal aortic approach successfully enabled TEVAR in a patient with inadequate femoral access.

Use of a synthetic graft and double tourniquets minimized bleeding and ensured a secure conduit for stent graft deployment.

Follow-up imaging showed no complications, endoleak, or aneurysm enlargement.

Abstract

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive treatment for descending thoracic aortic aneurysms, especially in high-risk patients; however, vascular access can be difficult in cases with small or calcified femoral arteries. Herein, we report a case of an 82-year-old woman with a descending thoracic aortic aneurysm who underwent TEVAR using an abdominal aortic approach because of inadequate femoral access. A synthetic graft was anastomosed to the abdominal aorta to provide a secure conduit for the deployment of the stent graft. The procedure was successfully completed without complications, and follow-up imaging revealed no endoleak or enlargement of the aneurysm. This case underscores the abdominal aortic approach as a safe and effective alternative for TEVAR in patients with complex vascular anatomy, offering favorable outcomes with technical refinements, such as placement of the synthetic graft and double tourniquets to minimize bleeding.

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