Antegrade delivery of a thoracic endovascular stent graft via axillary access with retrograde in situ laser fenestrations

<h2>ABSTRACT</h2> Thoracic endovascular aortic repair (TEVAR) is typically done through a retrograde transfemoral approach. However, it is not uncommon for the femoral or iliac arteries to be heavily diseased making retrograde delivery difficult. This has traditionally been addressed through open and endovascular conduits. We present a case of a patient with a ligated infrarenal aorta and a pseudoaneurysm arising from a supraceliac to bi-iliac bypass. This was subsequently treated via antegrade delivery of a TEVAR device via axillary access with in-situ laser fenestrations for the iliac limbs.