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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 reconstruction (A, B) revealed an abdominal aortic aneurysm with hostile neck anatomy. Continuous cross-section scanning (C–F) revealed an aneurismal neck mural thrombus covering 50% of the circumference and an imminent rupture of the aneurysm in the aneurismal neck area (F). Intraoperative DSA (G, H) revealed that the abdominal aortic aneurysm was well repaired with a fenestrated stent graft. The 3 target arterial branches were reconstructed using a balloon-expandable stent (Scuba, InvatecS.r.l., Italy) for the superior mesenteric artery, and 2 stent grafts (Viabahn; W.L. Gore & Associates, Inc., Flagstaff, AZ) were used for the reconstruction of the bilateral renal arteries. The CTA follow-up at 6 months after surgery (I, J) showed smooth flow in the target arteries, with no aneurysm endoleaks. CTA = computed tomographic angiography, DSA = digital subtraction angiography.
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Figure 4: Preoperative CTA reconstruction (A, B) revealed an abdominal aortic aneurysm with hostile neck anatomy. Continuous cross-section scanning (C–F) revealed an aneurismal neck mural thrombus covering 50% of the circumference and an imminent rupture of the aneurysm in the aneurismal neck area (F). Intraoperative DSA (G, H) revealed that the abdominal aortic aneurysm was well repaired with a fenestrated stent graft. The 3 target arterial branches were reconstructed using a balloon-expandable stent (Scuba, InvatecS.r.l., Italy) for the superior mesenteric artery, and 2 stent grafts (Viabahn; W.L. Gore & Associates, Inc., Flagstaff, AZ) were used for the reconstruction of the bilateral renal arteries. The CTA follow-up at 6 months after surgery (I, J) showed smooth flow in the target arteries, with no aneurysm endoleaks. CTA = computed tomographic angiography, DSA = digital subtraction angiography.

Mentions: A male patient, aged 66 years, had suffered continuous severe abdominal pain for 3 days and was transferred to our hospital with the diagnosis of abdominal aortic aneurysm revealed by a CTA examination. The patient had experienced complicated hypertension for 20 years, coronary heart disease for 5 years, coronary stent implantation 2 years prior, and diabetes for 3 years, psoriasis for 30 years, and gastroduodenal resection due to gastric ulcer 20 years before. Preoperative CTA (Fig. 4A–F) revealed a juxtarenal abdominal aortic aneurysm, with a 1/2 circumference mural thrombus in the aneurismal neck. After antihypertensive treatment, abdominal pain could not be completely relieved. In the second day after admission, a similar method of fenestration was applied for the endovascular repair of the abdominal aortic aneurysm (Fig. 4G, H), with the reconstruction of the superior mesenteric artery using a balloon-expandable stent and the reconstruction of the bilateral renal arteries using a stent graft (Viabahn, W.L. Gore & Associates, Inc., Flagstaff, AZ). The patient was successfully discharged after the surgery. The CTA follow-up at 6 months (Fig. 4I, J) after the surgery showed that the circulation of the superior mesenteric artery and bilateral renal arteries was smooth, with no endoleaks.


Application of physician-modified fenestrated stent graft in urgent endovascular repair of abdominal aortic aneurysm with hostile neck anatomy
Preoperative CTA reconstruction (A, B) revealed an abdominal aortic aneurysm with hostile neck anatomy. Continuous cross-section scanning (C–F) revealed an aneurismal neck mural thrombus covering 50% of the circumference and an imminent rupture of the aneurysm in the aneurismal neck area (F). Intraoperative DSA (G, H) revealed that the abdominal aortic aneurysm was well repaired with a fenestrated stent graft. The 3 target arterial branches were reconstructed using a balloon-expandable stent (Scuba, InvatecS.r.l., Italy) for the superior mesenteric artery, and 2 stent grafts (Viabahn; W.L. Gore & Associates, Inc., Flagstaff, AZ) were used for the reconstruction of the bilateral renal arteries. The CTA follow-up at 6 months after surgery (I, J) showed smooth flow in the target arteries, with no aneurysm endoleaks. CTA = computed tomographic angiography, DSA = digital subtraction angiography.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Preoperative CTA reconstruction (A, B) revealed an abdominal aortic aneurysm with hostile neck anatomy. Continuous cross-section scanning (C–F) revealed an aneurismal neck mural thrombus covering 50% of the circumference and an imminent rupture of the aneurysm in the aneurismal neck area (F). Intraoperative DSA (G, H) revealed that the abdominal aortic aneurysm was well repaired with a fenestrated stent graft. The 3 target arterial branches were reconstructed using a balloon-expandable stent (Scuba, InvatecS.r.l., Italy) for the superior mesenteric artery, and 2 stent grafts (Viabahn; W.L. Gore & Associates, Inc., Flagstaff, AZ) were used for the reconstruction of the bilateral renal arteries. The CTA follow-up at 6 months after surgery (I, J) showed smooth flow in the target arteries, with no aneurysm endoleaks. CTA = computed tomographic angiography, DSA = digital subtraction angiography.
Mentions: A male patient, aged 66 years, had suffered continuous severe abdominal pain for 3 days and was transferred to our hospital with the diagnosis of abdominal aortic aneurysm revealed by a CTA examination. The patient had experienced complicated hypertension for 20 years, coronary heart disease for 5 years, coronary stent implantation 2 years prior, and diabetes for 3 years, psoriasis for 30 years, and gastroduodenal resection due to gastric ulcer 20 years before. Preoperative CTA (Fig. 4A–F) revealed a juxtarenal abdominal aortic aneurysm, with a 1/2 circumference mural thrombus in the aneurismal neck. After antihypertensive treatment, abdominal pain could not be completely relieved. In the second day after admission, a similar method of fenestration was applied for the endovascular repair of the abdominal aortic aneurysm (Fig. 4G, H), with the reconstruction of the superior mesenteric artery using a balloon-expandable stent and the reconstruction of the bilateral renal arteries using a stent graft (Viabahn, W.L. Gore & Associates, Inc., Flagstaff, AZ). The patient was successfully discharged after the surgery. The CTA follow-up at 6 months (Fig. 4I, J) after the surgery showed that the circulation of the superior mesenteric artery and bilateral renal arteries was smooth, with no endoleaks.

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