Advanced Aortic Arch Procedure Successfully Performed by UHCW Vascular Team

The vascular surgery team at University Hospitals Coventry and Warwickshire (UHCW) NHS Trust has successfully completed another complex Zone 0 Thoracic Endovascular Aortic Repair (TEVAR) procedure, demonstrating the advanced capabilities of the multidisciplinary vascular group.

The patient had previously undergone endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm several months earlier using the Gore Conformable Excluder device. During follow-up imaging, clinicians identified a saccular thoracic aneurysm located along the inner curvature of the aortic arch, close to the origin of the left common carotid artery.

Given the complexity and location of the aneurysm, the vascular team developed a carefully planned hybrid approach to ensure safe treatment while maintaining uninterrupted blood flow to the brain.

The first stage of the procedure involved supra-aortic debranching, beginning with a carotid-to-carotid bypass tunnelled using a retropharyngeal approach. This method is preferred by the UHCW vascular team over the traditional sub-platysmal tunnelling technique.

Following this, a left common carotid artery to left subclavian artery bypass was performed, combined with left subclavian artery occlusion using an 18mm Amplatzer Vascular Plug. This dual bypass configuration allowed the team to complete the procedure without interrupting cerebral circulation, maintaining continuous blood flow to the brain throughout the operation.

Once the vascular bypasses had been established, the team proceeded with the Zone 0 TEVAR, deploying a Thoracic Branch Endoprosthesis (TBE) manufactured by W. L. Gore & Associates. The device was positioned to achieve full Zone 0 coverage of the aortic arch, incorporating a 12mm portal to maintain perfusion of the innominate artery.

The procedure was completed successfully, and the patient made an uneventful recovery, being discharged home just five days later.

The Gore Thoracic Branch Endoprosthesis is increasingly proving to be a significant advancement in the treatment of complex aortic arch disease, allowing vascular specialists to treat previously challenging aneurysms using minimally invasive endovascular techniques.

This case highlights the strength of the UHCW Vascular Group’s collaborative approach, combining advanced surgical planning, cutting-edge endovascular technology, and highly specialised multidisciplinary teamwork to deliver excellent patient outcomes.

At Sharkawy Vascular Clinic, the same commitment to advanced vascular care and evidence-based treatment underpins the clinic’s approach to diagnosing and managing complex arterial and venous disease.