In situ fenestration of a frozen elephant trunk prosthesis to recanalize the left subclavian artery

Figures

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  Fig 1. (A) A preoperative three-dimensional model demonstrating the extensive type 2 thoracoabdominal aneurysm. The length between ligation and frozen elephant trunk (FET) entry level and the maximal diameter are magnified. (B) A three-dimensional aortic model demonstrating the extra-anatomic left subclavian artery (LSA) bypass. Note the compression of the bypass behind the scapula (blue arrow). (C) A preoperative three-dimensional model demonstrating the FET and the LSA perfused retrogradely from left vertebral artery, due to bypass occlusion (blue arrow; lack of contrast enhancement due to occlusion).

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  Fig 2. (A) Angiography confirming the overcome of the left subclavian artery (LSA) ligation point (red arrow). (B) Snaring of the advanced wire through the newly introduced fenestration. (C) Image after the deployment of the second balloon expandable covered stent (red arrow, distal stenotic area-ligation site; blue arrow, proximal stenotic area in situ fenestration). (D) Balloon dilation from left brachial artery access to achieve antegrade orientation of the bridging stents. (E) Final angiography of the proximal aorta revealing patency and lack of target vessel-related endoleak for LSA. (F) Postoperative three-dimensional image of the aorta revealing patency and lack of target vessel-related endoleak for LSA.