Visceral ischemia with aortic stenosis - Our daily dilemma: Open or Endo?

Imagine treating a 68-year-old woman with visceral ischemia, complicated by CHF, HTN, obesity, and dyslipidemia. She suffers from postprandial abdominal pain, unintentional weight loss, and has a history of claudication with a bifurcated graft implantation. Explore potential therapeutic approaches for this challenging case!

Giovanni B. Torsello

University Medical Center Göttingen, Germany

Florian Elger

University Medical Center Göttingen, Germany

Giovanni F. Torsello

University Medical Center Göttingen, Germany

Part I - Case presentation

A 68-year-old woman with visceral ischemia

Risk factors: congestive heart failure (CHF), arterial hypertension (HTN), obesity, dyslipidemia
Postprandial abdominal pain increasing 15 minutes after eating
Unintentional weight loss
History of claudication and implantation of a bifurcated graft

Part II - Our treatment

We decided to opt for endovascular treatment of the coral reef aorta

Shockwave lithotripsy of the severe calcified visceral aorta

Pre-operative IVUS

Postoperative IVUS

→ After IVL, we saw an increased movement of the aortic wall, synchronized with the cardiac cycle

Stenting of the aorta (BMS, 12 x 60 mm GPS) and chimney for the celiac artery (7 x 22 mm, Advanta V12)

Periscope for the left renal artery (7 x 29 VBX) and kissing-ballooning (12 x 14 mm PTA of the aorta)

IVUS: lumen gain of the aorta

Angio: retrograde filling of SMA. Good patency of aorta, celiac and renal artery

Summary

A patient with visceral ischemia and coral-reef aorta was successfully treated by endovascular approach.
IVUS showed the increased compliance of the aortic wall after lithotripsy and lumen gain after using a bare metal stent.
Patient's state of health at the end of the treatment was excellent.
The three-month follow-up will include clinical examination, gain in weight, and duplex US.