Department of Peripheral Vascular Intervention, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas, USA.
J Endovasc Ther. 2010 Dec;17(6):705-11. doi: 10.1583/10-3170.1.
To report technical tips of endovascular aneurysm repair using Excluder endografts in patients with challenging infrarenal neck anatomy (short, angled, and/or tapered necks).
Several tips are presented to achieve effective and durable fixation and sealing of Excluder stent-grafts in abdominal aortic aneurysms (AAA) with challenging necks. The primary approach to patients with short infrarenal necks is a slow and controlled deployment combined with the bending-the-wire technique to realign the axis of the aneurysm and the axis of the neck. Severe infrarenal neck angulation is dealt with by bending the guidewire, orienting the iliac limbs of the Excluder in the anteroposterior direction, and using the slow and controlled endograft deployment technique. Other key procedural factors, such as using the percutaneous approach and local anesthetic, reorienting the stent-graft, using Excluder aortic extensions, employing the endowedge and kilt techniques, and using the appropriate C-arm angulation to adequately visualize the target landing zone, are also useful.
The techniques we describe have been valuable in achieving excellent outcomes with endovascular AAA treatment using the Excluder endoprosthesis in challenging infrarenal neck anatomy. Further improvements in device design and deployment mechanism will allow better device alignment in patients with complex infrarenal neck anatomy.
报告在肾下区解剖结构具有挑战性的患者中使用 Excluder 内置移植物进行血管内动脉瘤修复的技术要点。
介绍了几种技术，以实现 Excluder 支架移植物在具有挑战性的颈部的腹主动脉瘤（AAA）中的有效和持久固定和密封。对于肾下区短颈的患者，主要方法是缓慢而受控的展开，结合弯曲导丝技术来重新调整动脉瘤的轴和颈部的轴。严重的肾下区颈部成角通过弯曲导丝、将 Excluder 的髂肢定向在前后方向以及使用缓慢而受控的移植物展开技术来处理。其他关键手术因素，如使用经皮入路和局部麻醉、重新定向支架移植物、使用 Excluder 主动脉延长部分、使用 endowedge 和 kilt 技术以及使用适当的 C 臂角度充分可视化目标着陆区，也很有用。
我们描述的技术在使用 Excluder 内置假体在具有挑战性的肾下区解剖结构中进行血管内 AAA 治疗方面取得了优异的结果。进一步改进设备设计和部署机制将允许在具有复杂肾下区解剖结构的患者中更好地对齐设备。
