Salvage direct transabdominal aortic access enabled successful TEVAR stent graft deployment and complete pseudoaneurysm exclusion at 1 month in a patient with severe iliac artery spasm.
Case Report (n=1)
Salvage direct transabdominal aortic access serves as an effective and definitive bailout strategy for TEVAR when severe iliac artery spasm prevents conventional femoral device delivery.
• Although rare, iliac artery spasms can prevent femoral TEVAR device delivery, particularly with large-bore sheaths. • Salvage direct transabdominal aortic access is effective when pharmacological and endovascular measures fail, particularly in vessel injury. • Preprocedural planning should include a hierarchy of bailout strategies with immediate surgical expertise required. • Multidisciplinary coordination is critical for the timely recognition of access failure and safe conversion to an open access. : To describe salvage direct transabdominal aortic access as a bailout strategy for thoracic endovascular aortic repair (TEVAR) when bilateral iliac artery spasm precludes device delivery and to contextualize this approach among contemporary access techniques. A 58-year-old woman with a symptomatic thoracic aortic pseudoaneurysm underwent TEVAR. Bilateral femoral surgical cut-downs failed because of severe iliac artery spasm with >50% luminal narrowing and contrast extravasation despite maximal vasodilators and balloon angioplasty attempts. After recognizing definitive access failure, conversion to direct transabdominal aortic access was performed via midline laparotomy. A 21-French sheath (outer diameter ∼7.8 mm) was inserted under direct vision, which enabled successful stent graft deployment. Postoperative recovery was uneventful, and one-month CTA confirmed complete pseudoaneurysm exclusion and healed iliac access sites. However, a longer-term follow-up is recommended to assess the durability of aortic puncture sites. : Iliac artery spasm is a dynamic and under-recognized cause of TEVAR failure. When conventional measures fail, salvage direct transabdominal aortic puncture offers a definitive solution, underscoring the importance of surgical preparedness and structured bailout algorithms in complex endovascular therapy.
Yu et al. (Sun,) conducted a case report in Symptomatic thoracic aortic pseudoaneurysm (n=1). Salvage direct transabdominal aortic access was evaluated on Successful stent graft deployment and pseudoaneurysm exclusion. Salvage direct transabdominal aortic access enabled successful TEVAR stent graft deployment and complete pseudoaneurysm exclusion at 1 month in a patient with severe iliac artery spasm.