Two Cases of Thoracic Endovascular Aortic Repair Using the Carotid Artery as the Access Route

Riha Shimizu*	Makoto Sumi*	Yuri Murakami*
Takao Ohki**

(Department of Vascular Surgery, Saitama Cardiovascular and Respiratory Center*, Kumagaya, Japan, and Department of Surgery, Division of Vascular Surgery, The Jikei University School of Medicine**, Tokyo, Japan)

Thoracic Endovascular Aortic Repair (TEVAR) is widely used for high-risk patients with thoracic aortic pathology. However, access to the thoracic aorta can be difficult because TEVAR requires the introduction of a large a sheath especially in those with aortoiliac occlusive diseases and thoracic shaggy aorta. We herein report two cases of TEVAR in which the common carotid artery was used as the access route. Case 1 : An 86-year-old male patient whose past surgical history was significant for infected abdominal aortic aneurysm with abdominal aortic stump closed and axillo-bilateral femoral bypass. Computed tomography revealed a saccular aneurysm of the descending aorta, which required a carotid artery approach as the access route. Case 2 : A 79-year-old female patient who developed type A thoracic aortic dissection. She was considered to be of prohibitive risk for surgical repair and was treated conservatively. However, an intramural hematoma with an ulcer-like projection lesion in the ascending aorta expanded and definitive treatment was indicated. Because the descending aorta was significantly shaggy, we decided to perform TEVAR via the right common carotid artery as the access route. Both patients’ pathology was successfully treated and were discharged without any complications. TEVAR via common carotid artery access is a useful and safe procedure for patients in whom femoral and abdominal aortic aorta access is not feasible or safe.

 

Jpn. J. Cardiovasc. Surg. 51 : 39-43 (2022)

Keywords：stent graft ; thoracic aortic aneurysm ; aortic dissection ; carotid artery access