Application of Zenith t-Branch system in symptomatic thoracoabdominal aortic aneurysm with unfavourable anatomy — case report

Abstract

Although huge improvement has been observed in endovascular repair of aneurysms involving visceral arteries, in urgent cases open repair remained a method of choice. The aim was to present a patient with symptomatic thoracoabdominal aortic aneurysm measuring 11 cm in diameter (Crawford III). Due to concomitant medication and morphology of aorta, there was neither possibility for open repair, nor for standard stent-graft implantation. We decided to apply Zenith t-Branch system, though visceral arteries anatomy haven’t met morphological criteria from instruction for use (IFU) and previous guidelines — patient had critically stenosed coeliac trunk, steep left renal artery, blood to right kidney was supplied through the thick thrombus and two extra kidney arteries to the lower pole were present. At first, balloon was placed into the right renal artery to protect it from embolization. Next, after Zenith Tx2 stent-graft deployment, t-Branch system was implanted. Through branch dedicated to coeliac trunk, left kidney artery was bridged using Advanta stents. Superior mesenteric artery and right kidney artery were bridged by appropriate branches. All bridges were reinforced by Zilver stents. Branch dedicated to left renal artery was occluded using Amplatzer plug. Postoperative recovery and 4-month follow-up was uneventful. In control computed tomography performed at third month shrinking of the sac was observed to 96 mm and low-pressure type II endoleak between coeliac trunk and additional left renal arteries has been left for further observation. Application of Zenith t-Branch is feasible and efficient method of treatment in urgent cases, even if visceral arteries anatomy is outside IFU.