Double-Barreled and Branched Endografting for Thoracoabdominal Aortic Aneurysm: The Hexapus Technique

Objective: To treat thoracoabdominal aortic aneurysm (TAAA), we introduced an alternative “Hexapus” technique by double-barreled and branched endografting. Technique and Result: We established 2 transfemoral and 2 transaxillary access routes first and then deployed two abdominal bifurcated stentgrafts landing at the descending thoracic aorta through transfemoral routes, respectively. Two pairs of parallel stentgrafts were deployed via bilateral transaxillary route from each of contralateral limbs of main body stentgrafts to visceral arteries. Finally, we extended the ipsilateral limbs of main body stentgrafts to bilateral common iliac arteries as distal landings. The creation of six branches (four viscerals and two iliacs) resembles a hexapus. We have executed this Hexapus technique in three patients, and the final angiography during operation and postoperative 12-month image follow-up showed patent visceral branches and no any endoleaks. Conclusion: Our Hexapus technique is feasible in treating TAAA if patient is inoperable or no commercial fenestrated or branched stentgraft is available.