Publicação
One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device
| Resumo: | Background: The anatomical complexity of the aortic arch poses significant challenges to its repair, particularly in high-risk patients. The introduction of branched endografts, specifically designed to overcome these challenges, has revolutionized this field as demonstrated in the present case-report. Report: A 60-year-old male, with a prior history of smoking and neurosyphilis, was referenced to our outpatient clinic due to a CT finding of a 66mm aortic arch aneurysm with complex anatomical features, including a short brachiocephalic trunk and narrow iliac arteries. Thus, a staged hybrid approach was meticulously planned. The patient was initially submitted to a left carotid-subclavian bypass, followed by a right subclavian-carotid bypass. Later, an endoconduit was constructed using two GORE-Viabahn® stent grafts (11x100mm), deployed in the left common and external iliac arteries, facilitating subsequent TEVAR. Finally, the aneurysm was excluded using a custom-made Terumo-Relay® double inner-branched endograft (46x32x270mm) deployed in zone 0, with two inner branches for the brachiocephalic trunk (BCT)/right subclavian artery (RSA) and left common carotid artery (LCCA). The inner branches were catheterized via trans-carotid (left) and trans-axillary (right) accesses. An iliac extension GORE-Excluder® (16x12x100mm) to the BCT/RSA and a GORE-Viabahn® stent graft (7x75mm) to the LCCA were deployed. An additional extension endograft (34x30x150mm) was deployed to complete distal exclusion. The left subclavian artery was subsequently occluded using a vascular plug. Postoperatively, the patient experienced a minor posterior circulation stroke, with full recovery within two weeks. Six-month follow-up imaging showed patency of the endografts with complete exclusion of the aneurysm and no evidence of endoleaks. The patient remained asymptomatic, with no further vascular or neurological events. Conclusion: This case highlights the feasibility of a staged hybrid approach for complex aortic arch aneurysms in patients with challenging anatomy. The use of a custom-made endograft and careful preoperative planning proved critical to the success of the procedure. |
|---|---|
| Autores principais: | Carvalho, Patrícia |
| Outros Autores: | Brandão, Daniel; Fernandes, Luís; Machado, Marta; Basílio, Francisco; Guimarães, Beatriz; Rocha, Ana Margarida; Canedo, Alexandra |
| Assunto: | Endovascular Aneurysm Repair (MeSH) Branched TEVAR Hybrid procedures Aortic Aneurysm, Thoracic (MeSH) Stroke (MeSH) |
| Ano: | 2026 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | unknown |
| Instituição associada: | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| Idioma: | inglês |
| Origem: | Angiologia e Cirurgia Vascular |
| _version_ | 1869051323200045056 |
|---|---|
| author | Carvalho, Patrícia |
| author2 | Brandão, Daniel Fernandes, Luís Machado, Marta Basílio, Francisco Guimarães, Beatriz Rocha, Ana Margarida Canedo, Alexandra |
| author2_role | author author author author author author author |
| author_facet | Carvalho, Patrícia Brandão, Daniel Fernandes, Luís Machado, Marta Basílio, Francisco Guimarães, Beatriz Rocha, Ana Margarida Canedo, Alexandra |
| author_role | author |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Carvalho, Patrícia\"},{\"Person.name\":\"Brandão, Daniel\"},{\"Person.name\":\"Fernandes, Luís\"},{\"Person.name\":\"Machado, Marta\"},{\"Person.name\":\"Basílio, Francisco\"},{\"Person.name\":\"Guimarães, Beatriz\"},{\"Person.name\":\"Rocha, Ana Margarida\"},{\"Person.name\":\"Canedo, Alexandra\"}] |
| datacite.creators.creator.creatorName.fl_str_mv | Carvalho, Patrícia Brandão, Daniel Fernandes, Luís Machado, Marta Basílio, Francisco Guimarães, Beatriz Rocha, Ana Margarida Canedo, Alexandra |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Endovascular Aneurysm Repair (MeSH) Branched TEVAR Hybrid procedures Aortic Aneurysm, Thoracic (MeSH) Stroke (MeSH) |
| datacite.titles.title.fl_str_mv | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device |
| dc.creator.none.fl_str_mv | Carvalho, Patrícia Brandão, Daniel Fernandes, Luís Machado, Marta Basílio, Francisco Guimarães, Beatriz Rocha, Ana Margarida Canedo, Alexandra |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | https://doi.org/10.48750/acv.689 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.source.none.fl_str_mv | Angiologia e Cirurgia Vascular; Vol. 22 No. 1 (2026): March; 37 - 39 Angiologia e Cirurgia Vascular; Vol. 22 N.º 1 (2026): Março; 37 - 39 2183-0096 1646-706X |
| dc.subject.none.fl_str_mv | Endovascular Aneurysm Repair (MeSH) Branched TEVAR Hybrid procedures Aortic Aneurysm, Thoracic (MeSH) Stroke (MeSH) |
| dc.title.fl_str_mv | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | Background: The anatomical complexity of the aortic arch poses significant challenges to its repair, particularly in high-risk patients. The introduction of branched endografts, specifically designed to overcome these challenges, has revolutionized this field as demonstrated in the present case-report. Report: A 60-year-old male, with a prior history of smoking and neurosyphilis, was referenced to our outpatient clinic due to a CT finding of a 66mm aortic arch aneurysm with complex anatomical features, including a short brachiocephalic trunk and narrow iliac arteries. Thus, a staged hybrid approach was meticulously planned. The patient was initially submitted to a left carotid-subclavian bypass, followed by a right subclavian-carotid bypass. Later, an endoconduit was constructed using two GORE-Viabahn® stent grafts (11x100mm), deployed in the left common and external iliac arteries, facilitating subsequent TEVAR. Finally, the aneurysm was excluded using a custom-made Terumo-Relay® double inner-branched endograft (46x32x270mm) deployed in zone 0, with two inner branches for the brachiocephalic trunk (BCT)/right subclavian artery (RSA) and left common carotid artery (LCCA). The inner branches were catheterized via trans-carotid (left) and trans-axillary (right) accesses. An iliac extension GORE-Excluder® (16x12x100mm) to the BCT/RSA and a GORE-Viabahn® stent graft (7x75mm) to the LCCA were deployed. An additional extension endograft (34x30x150mm) was deployed to complete distal exclusion. The left subclavian artery was subsequently occluded using a vascular plug. Postoperatively, the patient experienced a minor posterior circulation stroke, with full recovery within two weeks. Six-month follow-up imaging showed patency of the endografts with complete exclusion of the aneurysm and no evidence of endoleaks. The patient remained asymptomatic, with no further vascular or neurological events. Conclusion: This case highlights the feasibility of a staged hybrid approach for complex aortic arch aneurysms in patients with challenging anatomy. The use of a custom-made endograft and careful preoperative planning proved critical to the success of the procedure. |
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| identifier.doi.fl_str_mv | https://doi.org/10.48750/acv.689 |
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| instname_str | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| language | eng |
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| network_name_str | Angiologia e Cirurgia Vascular |
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| person_str_mv | Carvalho, Patrícia Brandão, Daniel Fernandes, Luís Machado, Marta Basílio, Francisco Guimarães, Beatriz Rocha, Ana Margarida Canedo, Alexandra |
| publishDate | 2026 |
| publisher.none.fl_str_mv | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
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| spelling | en-USOne size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made deviceCarvalho, PatríciaBrandão, DanielFernandes, LuísMachado, MartaBasílio, FranciscoGuimarães, BeatrizRocha, Ana MargaridaCanedo, AlexandraEndovascular Aneurysm Repair (MeSH)Branched TEVARHybrid proceduresAortic Aneurysm, Thoracic (MeSH)Stroke (MeSH)Copyright (c) 2026 Angiologia e Cirurgia Vascularhttp://purl.org/coar/access_right/c_abf2https://doi.org/10.48750/acv.689DOIhttps://acvjournal.com/index.php/acv/article/view/689URLHasVersionhttps://acvjournal.com/index.php/acv/article/view/689/454URLHasVersionhttps://doi.org/10.48750/acv.689DOI2026-06-23en-USBackground: The anatomical complexity of the aortic arch poses significant challenges to its repair, particularly in high-risk patients. The introduction of branched endografts, specifically designed to overcome these challenges, has revolutionized this field as demonstrated in the present case-report. Report: A 60-year-old male, with a prior history of smoking and neurosyphilis, was referenced to our outpatient clinic due to a CT finding of a 66mm aortic arch aneurysm with complex anatomical features, including a short brachiocephalic trunk and narrow iliac arteries. Thus, a staged hybrid approach was meticulously planned. The patient was initially submitted to a left carotid-subclavian bypass, followed by a right subclavian-carotid bypass. Later, an endoconduit was constructed using two GORE-Viabahn® stent grafts (11x100mm), deployed in the left common and external iliac arteries, facilitating subsequent TEVAR. Finally, the aneurysm was excluded using a custom-made Terumo-Relay® double inner-branched endograft (46x32x270mm) deployed in zone 0, with two inner branches for the brachiocephalic trunk (BCT)/right subclavian artery (RSA) and left common carotid artery (LCCA). The inner branches were catheterized via trans-carotid (left) and trans-axillary (right) accesses. An iliac extension GORE-Excluder® (16x12x100mm) to the BCT/RSA and a GORE-Viabahn® stent graft (7x75mm) to the LCCA were deployed. An additional extension endograft (34x30x150mm) was deployed to complete distal exclusion. The left subclavian artery was subsequently occluded using a vascular plug. Postoperatively, the patient experienced a minor posterior circulation stroke, with full recovery within two weeks. Six-month follow-up imaging showed patency of the endografts with complete exclusion of the aneurysm and no evidence of endoleaks. The patient remained asymptomatic, with no further vascular or neurological events. Conclusion: This case highlights the feasibility of a staged hybrid approach for complex aortic arch aneurysms in patients with challenging anatomy. The use of a custom-made endograft and careful preoperative planning proved critical to the success of the procedure.Sociedade Portuguesa de Angiologia e Cirurgia Vascularapplication/pdfen-USAngiologia e Cirurgia Vascular; Vol. 22 No. 1 (2026): March; 37 - 39pt-PTAngiologia e Cirurgia Vascular; Vol. 22 N.º 1 (2026): Março; 37 - 392183-00961646-706Xengjournal articlehttp://purl.org/coar/resource_type/c_6501literatureVoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85 |
| spellingShingle | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device Carvalho, Patrícia Endovascular Aneurysm Repair (MeSH) Branched TEVAR Hybrid procedures Aortic Aneurysm, Thoracic (MeSH) Stroke (MeSH) |
| status | SINGLETON |
| status_str | VoR |
| subject.fl_str_mv | Endovascular Aneurysm Repair (MeSH) Branched TEVAR Hybrid procedures Aortic Aneurysm, Thoracic (MeSH) Stroke (MeSH) |
| title | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device |
| title_full | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device |
| title_fullStr | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device |
| title_full_unstemmed | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device |
| title_short | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device |
| title_sort | One size does not fit all – Staged hybrid approach of a challenging aortic arch aneurysm using a double-branch custom-made device |
| topic | Endovascular Aneurysm Repair (MeSH) Branched TEVAR Hybrid procedures Aortic Aneurysm, Thoracic (MeSH) Stroke (MeSH) |
| topic_facet | Endovascular Aneurysm Repair (MeSH) Branched TEVAR Hybrid procedures Aortic Aneurysm, Thoracic (MeSH) Stroke (MeSH) |
| url | https://doi.org/10.48750/acv.689 |
| visible | 1 |
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