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Endovascular treatment of infrarenal abdominal aortic aneurysm with short and angulated neck in high-risk patient.

Koutsias S, Antoniou G, Karathanos C, Saleptsis V, Stamoulis K, Giannoukas AD - Case Rep Vasc Med (2013)

Bottom Line: Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002).It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003).This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, 41000 Larissa, Greece.

ABSTRACT
Endovascular treatment of abdominal aortic aneurysms (AAA) is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006). Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009). The definition of a short and angulated neck is based on length (<15 mm), and angulation (>60°) (Hobo et al. 2007 and Chisci et al. 2009). A challenging neck also offers difficulties during open repairs (OR), necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002). It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003). In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

No MeSH data available.


Related in: MedlinePlus

Complete exclusion of the aneurysm on CT angiography one month postoperatively.
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fig4: Complete exclusion of the aneurysm on CT angiography one month postoperatively.

Mentions: A 30 mm diameter, free flow thoracic tube endograft (Valiant, Medtronic Vascular, Santa Rosa, CA, USA) was delivered in the proximal neck. Consequently, a bifurcated Talent (Medtronic Vascular, Santa Rosa, CA, USA) device 32X18X155 was deployed inside the Valiant graft, with adequate overlapping. Two sequential iliac extensions were deployed into the left external iliac artery, and a contralateral limb was placed to the right common iliac artery (Figure 3). CT angiogram at first month documented intact 3-component stent graft, with no endoleak or migration and no increase in aneurysm sac (Figure 4) A month later the left limb was occluded causing intermittent claudication. Endovascular attempt to salvage the left limb of the graft was unsuccessful due to the tortuosity of the external iliac artery. A crossover fem-fem PTFE graft (8 mm) was placed with full restoration of the blood flow to the left lower extremity. Nine (9) months postoperatively, the patient underwent CT angiography that showed no endoleak and good functioning of the thigh-femoral graft (Figure 5).


Endovascular treatment of infrarenal abdominal aortic aneurysm with short and angulated neck in high-risk patient.

Koutsias S, Antoniou G, Karathanos C, Saleptsis V, Stamoulis K, Giannoukas AD - Case Rep Vasc Med (2013)

Complete exclusion of the aneurysm on CT angiography one month postoperatively.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3713317&req=5

fig4: Complete exclusion of the aneurysm on CT angiography one month postoperatively.
Mentions: A 30 mm diameter, free flow thoracic tube endograft (Valiant, Medtronic Vascular, Santa Rosa, CA, USA) was delivered in the proximal neck. Consequently, a bifurcated Talent (Medtronic Vascular, Santa Rosa, CA, USA) device 32X18X155 was deployed inside the Valiant graft, with adequate overlapping. Two sequential iliac extensions were deployed into the left external iliac artery, and a contralateral limb was placed to the right common iliac artery (Figure 3). CT angiogram at first month documented intact 3-component stent graft, with no endoleak or migration and no increase in aneurysm sac (Figure 4) A month later the left limb was occluded causing intermittent claudication. Endovascular attempt to salvage the left limb of the graft was unsuccessful due to the tortuosity of the external iliac artery. A crossover fem-fem PTFE graft (8 mm) was placed with full restoration of the blood flow to the left lower extremity. Nine (9) months postoperatively, the patient underwent CT angiography that showed no endoleak and good functioning of the thigh-femoral graft (Figure 5).

Bottom Line: Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002).It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003).This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, 41000 Larissa, Greece.

ABSTRACT
Endovascular treatment of abdominal aortic aneurysms (AAA) is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006). Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009). The definition of a short and angulated neck is based on length (<15 mm), and angulation (>60°) (Hobo et al. 2007 and Chisci et al. 2009). A challenging neck also offers difficulties during open repairs (OR), necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002). It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003). In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

No MeSH data available.


Related in: MedlinePlus