Concomitant carotid-carotid-axillary bypass with zone 0 branched endograft and transcatheter aortic valve-in-valve replacement via retroperitoneal access

Figures

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  3D reconstruction: branched zone 0 TEVAR with carotid-carotid-axillary bypasses and TAVR.

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  Figure 1. A-C, Preoperative CTA and reconstruction showing multiple pseudoaneurysms arising from the dehisced distal hemiarch anastomosis and calcified true lumen of the native arch. CTA, Computed tomography angiography.

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  Figure 2. A-C, Postoperative CTA and reconstruction of the postoperative CT scan showing excluded pseudoaneurysms, no endoleaks and patent bypass grafts. CTA, Computed tomography angiography; CT, computed tomography.

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  Figure E1. A, Ring-reinforced PTFE grafts routed in the retropharyngeal and retroclavicular routes before heparinization. B and C, retroperitoneal conduit construction to the right common iliac artery and externalization into the right groin for large bore sheath access. PTFE, Polytetrafluoroethylene.

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  Figure E2. A, Aortogram shows circumferential pseudoaneurysms around the distal ascending aorta and evidence of severe AI. B, Shows the deployed TBE and side branch with exclusion of the pseudoaneurysms and occlusion of the native left carotid and left subclavian orifices. C, Evolut FX TAVR valve deployed in a ViV fashion. D, Carotid-to-carotid bypasses and left carotid to axillary bypasses (before proximal ligation). AI, Aortic insufficiency; TBE, thoracic branched endoprosthesis; TAVR, transcatheter aortic valve replacement; ViV, valve-in-valve.