Vascular repairs in a heavy smoker

Case contributed by Dr Sajoscha Sorrentino

Presentation

Coronary artery bypass surgery, endovascular repair of an abdominal aortic aneurysm and femoro-femoral crossover bypass grafting didn't stop this man from smoking ...

Patient Data

Age: 65
Gender: Male
DSA (angiography)

After endovascular repair of an abdominal aortic aneurysm you can see 

- the frame of the covered aortic stent,

- chimney grafts to the superior mesenteric artery and the left renal artery (right kidney is not perfused),

- stents in the common iliac arteries with occlusion of the right-sided stent,

- and a femoro-femoral crossover graft bypassing the occlosion of the right common iliac artery.

Case Discussion

A covered stent is deployed parallel to the main aortic stent-graft, protruding somewhat proximally, like a chimney, to preserve flow to a vital side branch covered by the aortic stent-graft. Use of a chimney graft makes it possible to use standard off-the-shelf stent-grafts to instantly treat lesions with inadequate fixation zones, providing an alternative to fenestrated stent-grafts in urgent cases, in aneurysms with challenging neck morphology, and for reconstituting an aortic side branch unintentionally compromised during endovascular repair.1

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