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Application of physician-modified fenestrated stent graft in urgent endovascular repair of abdominal aortic aneurysm with hostile neck anatomy

View Article: PubMed Central - PubMed

ABSTRACT

Background:: This study aimed to evaluate the feasibility and effectiveness of the Gore Excluder aortic stent graft (WL Gore & Associates, Inc., Flagstaff, AZ) using the C3 Delivery System after physician modification of fenestration for the urgent treatment of patients with abdominal aortic aneurysm showing hostile neck anatomy.

Case summary:: Three urgent cases of abdominal aortic aneurysm with hostile neck anatomy symptom with abdominal pain were reported. The same fenestration method was applied to align the target superior mesenteric artery and bilateral renal arteries with 1 scallop and 2 fenestrations, followed by the reconstruction of the target artery using a bare-metal stent or stent graft. Balloon-assisted positioning and image fusion technology were intraoperatively applied to assist the accurate release of the stent graft body. The follow-up periods for all cases exceeded 6 months, showing smooth circulation in the target arteries with no endoleaks.

Conclusion:: In the absence of other available treatment methods, it is feasible to use a stent graft with physician-modified fenestration for the urgent endovascular repair of abdominal aortic aneurysm with hostile neck anatomy. However, this procedure's long-term efficacy needs to be further investigated.

No MeSH data available.


Related in: MedlinePlus

Preoperative CTA (A) showed an abdominal aortic pseudoaneurysm located in the posterior wall of the abdominal aorta at the level of the renal artery (white arrow in A) and an aortic pseudoaneurysm located in the anterior wall of the end of the abdominal aorta (white arrowhead in A). A balloon catheter (EverCross, ev3 Inc.) was intraoperatively (B, C) placed in the superior mesenteric artery (white arrowhead in B) to assist with the release of the stent graft body so that the “V”-shaped scallop could be aligned to the opening of the mesenteric artery. The target arteries’ openings were labeled using image-fusion technology (white arrows in B) so that they were always visible in fluoroscopy imaging. Using the approach from the upper-limb arteries, the bilateral renal arteries could be selected through the fenestrations (C). The CTA follow-up at 6 months after surgery showed that (D) the circulation of the superior mesenteric artery and bilateral renal arteries was smooth and that the pseudoaneurysm was isolated completely, with no endoleak. CTA = computed tomographic angiography.
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Figure 1: Preoperative CTA (A) showed an abdominal aortic pseudoaneurysm located in the posterior wall of the abdominal aorta at the level of the renal artery (white arrow in A) and an aortic pseudoaneurysm located in the anterior wall of the end of the abdominal aorta (white arrowhead in A). A balloon catheter (EverCross, ev3 Inc.) was intraoperatively (B, C) placed in the superior mesenteric artery (white arrowhead in B) to assist with the release of the stent graft body so that the “V”-shaped scallop could be aligned to the opening of the mesenteric artery. The target arteries’ openings were labeled using image-fusion technology (white arrows in B) so that they were always visible in fluoroscopy imaging. Using the approach from the upper-limb arteries, the bilateral renal arteries could be selected through the fenestrations (C). The CTA follow-up at 6 months after surgery showed that (D) the circulation of the superior mesenteric artery and bilateral renal arteries was smooth and that the pseudoaneurysm was isolated completely, with no endoleak. CTA = computed tomographic angiography.

Mentions: A male patient, aged 43 years, had suffered from abdominal pain accompanied by a high fever for 3 months and was diagnosed with infectious abdominal aortic aneurysms. The blood culture from another hospital revealed Klebsiella pneumoniae. Before being transferred to our hospital, he had received intravenous antibiotic that was effective against the bacteria for 6 weeks, with a normal body temperature and hemogram for 4 weeks, but the abdominal pain was not completely relieved. The patient had undergone laparotomy a year before for drainage around the pancreas due to acute severe pancreatitis. Preoperative computed tomographic angiography (CTA) (Fig. 1A) suggested 2 abdominal aortic pseudoaneurysms, which were located in the posterior wall of the abdominal aorta and the anterior wall of the end of the abdominal aorta at the level of the renal artery.


Application of physician-modified fenestrated stent graft in urgent endovascular repair of abdominal aortic aneurysm with hostile neck anatomy
Preoperative CTA (A) showed an abdominal aortic pseudoaneurysm located in the posterior wall of the abdominal aorta at the level of the renal artery (white arrow in A) and an aortic pseudoaneurysm located in the anterior wall of the end of the abdominal aorta (white arrowhead in A). A balloon catheter (EverCross, ev3 Inc.) was intraoperatively (B, C) placed in the superior mesenteric artery (white arrowhead in B) to assist with the release of the stent graft body so that the “V”-shaped scallop could be aligned to the opening of the mesenteric artery. The target arteries’ openings were labeled using image-fusion technology (white arrows in B) so that they were always visible in fluoroscopy imaging. Using the approach from the upper-limb arteries, the bilateral renal arteries could be selected through the fenestrations (C). The CTA follow-up at 6 months after surgery showed that (D) the circulation of the superior mesenteric artery and bilateral renal arteries was smooth and that the pseudoaneurysm was isolated completely, with no endoleak. CTA = computed tomographic angiography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120954&req=5

Figure 1: Preoperative CTA (A) showed an abdominal aortic pseudoaneurysm located in the posterior wall of the abdominal aorta at the level of the renal artery (white arrow in A) and an aortic pseudoaneurysm located in the anterior wall of the end of the abdominal aorta (white arrowhead in A). A balloon catheter (EverCross, ev3 Inc.) was intraoperatively (B, C) placed in the superior mesenteric artery (white arrowhead in B) to assist with the release of the stent graft body so that the “V”-shaped scallop could be aligned to the opening of the mesenteric artery. The target arteries’ openings were labeled using image-fusion technology (white arrows in B) so that they were always visible in fluoroscopy imaging. Using the approach from the upper-limb arteries, the bilateral renal arteries could be selected through the fenestrations (C). The CTA follow-up at 6 months after surgery showed that (D) the circulation of the superior mesenteric artery and bilateral renal arteries was smooth and that the pseudoaneurysm was isolated completely, with no endoleak. CTA = computed tomographic angiography.
Mentions: A male patient, aged 43 years, had suffered from abdominal pain accompanied by a high fever for 3 months and was diagnosed with infectious abdominal aortic aneurysms. The blood culture from another hospital revealed Klebsiella pneumoniae. Before being transferred to our hospital, he had received intravenous antibiotic that was effective against the bacteria for 6 weeks, with a normal body temperature and hemogram for 4 weeks, but the abdominal pain was not completely relieved. The patient had undergone laparotomy a year before for drainage around the pancreas due to acute severe pancreatitis. Preoperative computed tomographic angiography (CTA) (Fig. 1A) suggested 2 abdominal aortic pseudoaneurysms, which were located in the posterior wall of the abdominal aorta and the anterior wall of the end of the abdominal aorta at the level of the renal artery.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: This study aimed to evaluate the feasibility and effectiveness of the Gore Excluder aortic stent graft (WL Gore & Associates, Inc., Flagstaff, AZ) using the C3 Delivery System after physician modification of fenestration for the urgent treatment of patients with abdominal aortic aneurysm showing hostile neck anatomy.

Case summary:: Three urgent cases of abdominal aortic aneurysm with hostile neck anatomy symptom with abdominal pain were reported. The same fenestration method was applied to align the target superior mesenteric artery and bilateral renal arteries with 1 scallop and 2 fenestrations, followed by the reconstruction of the target artery using a bare-metal stent or stent graft. Balloon-assisted positioning and image fusion technology were intraoperatively applied to assist the accurate release of the stent graft body. The follow-up periods for all cases exceeded 6 months, showing smooth circulation in the target arteries with no endoleaks.

Conclusion:: In the absence of other available treatment methods, it is feasible to use a stent graft with physician-modified fenestration for the urgent endovascular repair of abdominal aortic aneurysm with hostile neck anatomy. However, this procedure's long-term efficacy needs to be further investigated.

No MeSH data available.


Related in: MedlinePlus