title: The Loop Technique: Addressing Celiac Artery Dissection in a Branched and Fenestrated Endograft for the Treatment of a Type III Thoracoabdominal Aneurysm.
abstract: OBJECTIVE
  To describe a bailout technique for use during branched/fenestrated thoracoabdominal aortic aneurysm (TAAA) repair to address celiac artery (CA) dissection.
  
  
  METHODS
  The technique is demonstrated in a 69-year-old man who underwent fenestrated stent-graft repair of a 6-cm type III TAAA. The main fenestrated stent-graft was positioned without difficulty, and the renal and superior mesenteric arteries were stented. A stent-graft was placed in the CA, but angiography showed the vessel to be occluded by dissection beyond the stent-graft. Wire manipulations to regain access to the true lumen culminated in perforation. At this point, the gastroduodenal artery was catheterized with a 0.035-inch guidewire, which was advanced in retrograde fashion into the CA true lumen and then snared back to the left brachial artery forming a loop. After exchange for a 0.014-inch system, self-expanding stents were deployed into the hepatic artery. Postoperative recovery was uneventful, and the patient was discharged on day 6. At 1-year follow-up, the patient was doing very well. Imaging demonstrated no endoleak, no graft migration, and sac shrinkage to a diameter of 5.1 cm.
  
  
  CONCLUSIONS
  The "loop technique" can be a very useful and effective bailout maneuver in regaining access to the true lumen of a dissected CA in patients undergoing branched/fenestrated thoracoabdominal aortic aneurysm repair.
authors.affiliation: Section of Vascular and Endovascular Surgery, Yale University, New Haven, CT, USA.
authors.forename: Young
authors.initials: Y
authors.lastname: Erben
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA oderich.gustavo@mayo.edu.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D001916:Brachial Artery / Q000000981:diagnostic imaging; D002406:Catheterization, Peripheral / Q000379:methods*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography; D004386:Duodenum / Q000098:blood supply*; D057510:Endovascular Procedures / Q000295:instrumentation*; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D013270:Stomach / Q000098:blood supply*; D016896:Treatment Outcome
keywords: celiac artery; dissection; fenestrated stent-graft; thoracoabdominal aortic aneurysm