Periscope technique combined with initial deployment of the distal segment in C-TAG stent-graft in treating the distal entry tear after TEVAR

Abstract

Introduction: Distal tears are an important issue after thoracic endovascular aortic repair as they directly affect thrombosis in the false lumen. However, it is difficult to treat distal tears in clinical practice due to the potential complications that may occur.Case report: We report the case of a 58-year-old male patient who received a GORE C-TAG stent placement by means of a “triple periscope technique” (a stent graph was placed in the superior mesenteric artery (SMA) and the bilateral renal artery). Post-CTA imaging three months later indicated that the distal dissecting aortic aneurysm was successfully isolated, and the three abdominal branches were well-perfused, interestingly the celiac branch with well–perfusion via collateral circulation pathway between the celiac trunk and the superior mesenteric artery.Conclusions: The periscope technique used in this report for reconstructing the branch vessel involved in the dissecting aneurysm was easy to learn and operate. Combined with another skill that initial deployment in the distal segment of stent-graft, distal entry tear of aortic dissecting aneurysm could be ensured with accurate coverage, as well as well-perfusion in the abdominal branches.

Keywords

• Thoracic endovascular aortic repair
• Periscope technique
• Distal tears
• Stent graft
• Aortic dissection