Overview
Thoraco-abdominal enteric duplication anomalies involve abnormal tubular structures that extend from the gastrointestinal tract into the thoraco-abdominal region, potentially complicating aortic interventions like endovascular aneurysm repair (EVAR). These duplications can affect visceral arteries and necessitate specialized techniques to ensure patency and successful repair. 123Diagnosis
Imaging studies (CT angiography, MRI) essential for identifying anatomical anomalies and assessing visceral artery involvement.
Endoscopic or surgical exploration may be required for definitive diagnosis and characterization of the duplication structure.
Evaluation of renal artery orientation and visceral artery patency crucial in planning endovascular procedures. 13Management
First-line treatments: Endovascular techniques such as branched endovascular aortic repair (BEVAR) and fenestrated endovascular aortic repair (FEVAR) for managing thoraco-abdominal aortic aneurysms (TAAAs).
Adjunctive techniques:
- Hybrid stent graft techniques combining self-expandable and balloon-expandable stents for hostile renal arteries. 1
- Electrocautery septotomy to facilitate deployment of branched endografts in post-dissection aneurysms with complex anatomy. 2
Experimental approaches: Development and experimental use of modular endovascular grafts designed to preserve visceral artery perfusion while excluding aneurysms. 3Special Populations
Elderly patients: Subcostal (transabdominal) approaches may be considered to mitigate respiratory complications, though outcomes vary and require careful preoperative assessment of pulmonary function. 4
Comorbidities: Preoperative evaluation of pulmonary function is critical, especially in patients undergoing elective repair of Type IV TAAAs, as it predicts postoperative outcomes. 4Key Recommendations
Utilize hybrid stent graft techniques combining different stent types to ensure renal artery patency in hostile anatomies during BEVAR/FEVAR procedures. (Evidence: Moderate) 1
Consider electrocautery septotomy as an adjunctive technique to facilitate endovascular repair in complex post-dissection TAAA cases with chronic septum challenges. (Evidence: Weak) 2
Evaluate pulmonary function rigorously in elderly and comorbid patients prior to elective thoraco-abdominal aortic aneurysm repair, particularly when considering subcostal approaches. (Evidence: Moderate) 4References
1 Gallitto E, Faggioli G, Vacirca A, Tenorio ER, Mendes BC, Lodato M et al.. Editor's Choice - Hybrid Stent Graft Technique in Bridging Hostile Renal Arteries in Thoraco-abdominal Branched Endografting. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2025. link
2 Bastianon M, Di Gregorio S, Melani C, Mena Vera JM, Mozzetta G, Grimaldi F et al.. Visceral Aorta Electrocautery Septotomy to Allow Branched Endovascular Aortic Repair in Ruptured Chronic Post-Dissection Thoraco-Abdominal Aneurysm. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2025. link
3 Di Centa I, Coggia M, Bonneau M, Goëau-Brissonnière O. Experimental development of an endovascular graft for thoraco-abdominal aortic aneurysm repair. The Journal of cardiovascular surgery 2005. link
4 Brooks MJ, Bradbury A, Wolfe HN. Elective repair of type IV thoraco-abdominal aortic aneurysms; experience of a subcostal (transabdominal) approach. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 1999. link