Question:
How is blood flow maintained to the brachiocephalic vessels when a thoracic endograft would otherwise cover the innominate, left common carotid, or left subclavian arteries?
Answer:
Fenestrations within the fabric allow for selective catheterization of the branch vessels and subsequent placement of an endoprosthesis to maintain flow to the branch artery. Parallel stent grafts placed alongside the thoracic graft permit branch flow to the brachiocephalic vessels that preserve flow to these critical branches otherwise covered by the thoracic endograft. Anatomic variation in the location and orientation of the brachiocephalic (innominate, left common carotid, left subclavian) artery origins requires use of a patient-specific fenestrated endograft for endovascular repair that preserves flow to essential arteries and that allows proximal seal and fixation to be achieved. These procedures involve selective catheterization.
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