Abstract
Objective: Debranching thoracic endovascular aortic repair (TEVAR), in which endovascular stent-grafting with cervical vascular reconstruction for aortic aneurysm arch lesion is increasing, and these cases have difficulties in access during neuroendovascular treatment. In this study, we investigated the selection of appropriate access route according to the methods of debranching TEVAR during neuroendovascular treatment.
Methods: We examined a zone classification of aortic lesion, the number of debranch, and vascular reconstruction techniques of debranching TEVAR and assessed an optimal access route for each debranching TEVAR reconstruction method.
Results: Four patients underwent neuroendovascular treatment after debranching TEVAR. Aortic lesion of each patient located in zone 0 in 1 patient, zone 1 in 2 patients, and was unclassifiable in 1 patient. Total debranching was performed in 1 case, 2 cases of 2-debranching, and 1 case of 1-debranching with chimney reconstruction. The pathologies treated included 1 unruptured basilar artery aneurysm, 1 direct carotid cavernous fistula, 1 subclavian artery aneurysm, and 1 acute basilar artery occlusion.
The access routes selected were the brachial artery approach in 3 cases and direct puncture of right common carotid artery in 1 case. Optimal access route selection for each method of debranching TEVAR resulted in no complications associated with the access route and technical success in all cases.
Conclusion: With the expansion of indications for debranching TEVAR, opportunities for neuroendovascular treatment of these patients will increase. Physicians need to be aware of the problems of access routes for neuroendovascular treatment in patients with debranching TEVAR.
