Endovascular ascending aortic pseudoaneurysm repair under image fusion guidance and transcranial Doppler monitoring

Lauren A Fitzgerald; Lamees I El Nihum; Pauline M Berens; Ponraj Chinnadurai; Zsolt Garami; Marvin D Atkins

doi:10.1016/j.jvscit.2022.06.009

Endovascular ascending aortic pseudoaneurysm repair under image fusion guidance and transcranial Doppler monitoring

J Vasc Surg Cases Innov Tech. 2022 Jul 9;8(3):425-428. doi: 10.1016/j.jvscit.2022.06.009. eCollection 2022 Sep.

Authors

Lauren A Fitzgerald^{1

2}, Lamees I El Nihum^{1

2}, Pauline M Berens³, Ponraj Chinnadurai^{2

4}, Zsolt Garami², Marvin D Atkins²

Affiliations

¹ Texas A&M College of Medicine, Bryan, TX.
² DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX.
³ Baylor College of Medicine, Houston, TX.
⁴ Advanced Therapies, Siemens Medical Solutions USA, Inc., Malvern, PA.

Abstract

We describe a 78-year-old woman with a large ascending aortic pseudoaneurysm who underwent thoracic endovascular aortic repair under intraoperative image fusion guidance and real-time transcranial Doppler (TCD) monitoring. TCD monitoring revealed a total of 419 microembolic signals throughout the procedure, with the majority occurring as the first stent graft crossed the ascending aorta. Two days later, she underwent endovascular repair of a graft type IA endoleak. We highlight the role of image fusion guidance and TCD monitoring in enabling successful thoracic endovascular aortic repair in an elderly woman and in identifying procedural areas of improvement to minimize stroke risk.

Keywords: Image fusion; TEVAR; Transcranial Doppler.

Publication types

Case Reports