Forced complete femoral approach for urgent thoracoabdominal aneurysm repair using an inner branched endograft

Abstract Introduction A successful case of urgent type ll thoracoabdominal aneurysm repair with an inner branched endograft conducted entirely through femoral accesses without the bailout possibility to achieve an upper extremity approach for bridging stents delivery is described. Case description A 70-year-old male patient underwent hybrid treatment of a thoracic aortic aneurysm on complicated type B dissection in two steps. First, arch debranching with carotid-carotid-subclavian bypass and then ascending aortic replacement with re-implantation of the anonymous trunk plus TEVAR were performed. The scheduled one-month control CTA showed a rapid increase of the false lumen thoracoabdominal aneurysm, with axial diameter measuring more than 10 cm. The repair procedure was based on the use, as off-the-shelf graft, of a prosthesis customized for another patient with inner-branches for visceral vessels that well suited the characteristics of the case. A steerable guiding sheath was essential to stabilize the system in the selective and sequential cannulation of two of the four inner-branches (for celiac trunk and superior mesenteric artery) and to complete the bridging stents deployment. Procedure was carried out without complications. Conclusion In an urgent setting, total endovascular correction of a thoracoabdominal aortic aneurysm exclusively through femoral accesses appears to be feasible when the appropriate tools are available.