Oderich Gustavo S, Ricotta Joseph J
Division of Vascular and Endovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Perspect Vasc Surg Endovasc Ther. 2009 Sep;21(3):157-67. doi: 10.1177/1531003509351594. Epub 2009 Dec 3.
Patients with aneurysms with short or angulated necks and those with involvement of the renal, visceral, and hypogastric arteries may not be candidates for endovascular treatment using infrarenal stent graft. Fenestrated stent grafts with reinforced fenestrations permit the incorporation of the visceral and renal arteries into the endovascular repair enabling an adequate proximal sealing zone. These devices require a 6-week to 8-week period for customization and are not currently commercially available in the United States. Modified fenestrated stent grafts may have a future role in the compassionate treatment of selected high-risk patients with complex aneurysms who otherwise would not have access to a manufactured fenestrated stent graft, or for those in need of urgent or emergent repair because of impending or contained ruptured, rapidly expanding or excessively large aneurysm. The authors have used modified fenestrated stent grafts selectively in patients with large aortoiliac, juxtarenal, pararenal, or thoracoabdominal aortic aneurysms. In this article, the authors summarize the principles applied for device design and procedure planning, as well as the technique for device modification and implantation.
颈部短或呈角状的动脉瘤患者以及肾动脉、内脏动脉和下腹动脉受累的患者可能不适合使用肾下型覆膜支架进行血管内治疗。带有强化开窗的开窗型覆膜支架可将内脏动脉和肾动脉纳入血管内修复，从而获得足够的近端密封区。这些装置需要6至8周的定制时间，目前在美国尚无商业供应。改良开窗型覆膜支架可能在某些复杂动脉瘤高危患者的同情治疗中发挥未来作用，这些患者否则无法获得定制的开窗型覆膜支架，或者对于因动脉瘤即将破裂、已破裂、迅速扩大或过大而需要紧急或急诊修复的患者。作者已在患有大型主髂动脉、肾旁、肾周或胸腹主动脉瘤的患者中选择性地使用改良开窗型覆膜支架。在本文中，作者总结了应用于装置设计和手术规划的原则，以及装置改良和植入技术。
