Avoiding Trouble: A Hybrid Procedure to Treat a Visceral Patch Aneurysm after Thoraco-abdominal Aneurysm Repair

Andrew M. Bakken, Clinton D. Protack, MD, David L. Waldman, MD and Mark G. Davies, MD
University of Rochester, Rochester, NY

BACKGROUND: Visceral patch aneurysm is a significant complication after extensive thoraco-abdominal aneurysm repair and open procedures to correct these lesions are associated with a 50% peri-operative mortality. We report the case of a 6cm visceral patch aneurysm corrected by staged debranching and endovascular repair with dedicated thoracic device.
CASE REPORT: 56 yr old female presented with central abdominal pain and a history of Type I Thoracoabdominal aneurysm repair followed several years later by an infrarenal aneurysm repair and left nephrectomy. MRA and preoperative angiogram demonstrated a 6 cm visceral patch aneurysm with patent visceral vessels (Fig 1). The patient underwent a transperitoneal debranching procedure during which a trifurcated PTFE graft was taken from the pre-existing infrarenal aortic graft and used to bypass the celiac, SMA and right renal vessels. These vessels were ligated at their origins (Fig 2). Fourteen days later, a series of Gore TAG devices were deployed to exclude the visceral patch aneurysm (Fig 3). At one year follow up the aneurysm remains excluded without endoleak and the patient has returned to normal affairs of daily living.
CONCLUSION: Hybrid procedures are a successful option to treat complex repairs in the reoperative setting. They have the potential to lower perioperative risk and enhance patient care.