Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Vasc Surg. 2010 Oct;52(4):1048-51. doi: 10.1016/j.jvs.2010.05.009. Epub 2010 Jul 23.
During the past 20 years, open repair has been the chief intervention for pararenal abdominal aortic aneurysm (AAA). Endovascular repair has become an alternative for patients with ruptured AAA or other acute disease complications. The present study, however, attempted to use a common stent graft with the fenestration technique, rather than a customized one, in an emergency situation, to treat a giant pararenal AAA complicated by upper digestive tract obstruction, and assessed the results.
A patient with a pararenal AAA was admitted emergently, with complications of upper digestive tract obstruction, including a tumor-like dilated segment of the abdominal aorta, 0.5-cm inferior to the ostia of the bilateral renal arteries, with a maximum diameter of 10.1 cm and a length of 18.5 cm. The patient underwent endovascular repair with a fenestrated endovascular stent graft to open the bilateral renal arteries 1 week later in an emergency situation.
No stenosis occurred at the openings of bilateral renal artery as a result of the stent, and the AAA was completely occluded. The patient experienced greatly ameliorated abdominal pain and upper digestive tract obstruction. At the 1-year follow-up examination, no exceptional symptoms were observed.
These results showed that for patients with a pararenal AAA who are unfit for open repair, or for those who cannot wait longer than 6 weeks for a customized fenestrated stent graft to be made, emergency field fenestration is feasible and successful, based on selection of the proper patient and accurate intraoperative localization.
在过去的 20 年中，开放修复一直是肾周腹主动脉瘤（AAA）的主要治疗方法。血管内修复已成为破裂 AAA 或其他急性疾病并发症患者的替代方法。然而，本研究试图在紧急情况下使用带开窗技术的通用支架移植物，而不是定制支架移植物，来治疗伴有上消化道梗阻的巨大肾周 AAA，并评估其结果。
一名肾周 AAA 患者因上消化道梗阻并发症紧急入院，包括腹主动脉下段 0.5cm 处肿瘤样扩张段，双侧肾动脉开口以下，最大直径 10.1cm，长 18.5cm。1 周后，该患者在紧急情况下接受了带开窗的血管内支架移植物的血管内修复，以打开双侧肾动脉。
支架未导致双侧肾动脉开口狭窄，AAA 完全闭塞。患者腹痛和上消化道梗阻明显改善。在 1 年的随访检查中，未观察到异常症状。
这些结果表明，对于不适合开放修复的肾周 AAA 患者，或者对于那些不能等待超过 6 周定制开窗支架移植物制作完成的患者，基于选择合适的患者和术中准确的定位，紧急现场开窗是可行且成功的。
