Vascular Center Malmö-Lund, Skåne University Hospital, Sweden.
Eur J Vasc Endovasc Surg. 2012 Jun;43(6):655-60. doi: 10.1016/j.ejvs.2012.01.022. Epub 2012 Feb 18.
The use of EVAR for more complex aneurysm anatomy has become more widespread over the past decade. Fenestrated and branched stent grafts for the visceral and iliac segment show promising short- and midterm outcome and these procedures have become routine in many vascular centers. However, at present, such grafts are customized to the individual patient and planning and manufacturing leads to significant treatment delay subjecting the patients to the risk of rupture during the waiting period. The purpose of this report is to describe the first experience in treating juxta/suprarenal aneurysms using the first version of a new fenestrated stent graft
A fenestrated device was designed with two renal fenestrations, an SMA fenestration and a scallop for the coeliac artery. The renal arteries were designed with an inner 6 mm fenestration and an outer 15 mm diameter creating a dome to allow renal artery catheterization for a range of renal artery distribution. Seven patients with complex visceral artery anatomy were treated with customized stent grafts containing these pivot renal fenestrations.
Technical success was uniform with 100% target vessel catheterization and 0% 30-day mortality. In one case, the graft was displaced slightly during delivery resulting in a renal artery stent occlusion at 2 months postoperatively.
The development of a modified fenestrated device has shown this to be feasible and it has the potential to reduce the need for extensive preoperative graft customization and establishing a true off the shelf platform for juxta- and suprarenal AAA.
在过去十年中，EVAR 已被更广泛地用于治疗更复杂的动脉瘤解剖结构。内脏和髂动脉段的开窗和分支支架移植物具有良好的短期和中期效果，这些手术在许多血管中心已成为常规手术。然而，目前这些移植物是根据患者个体定制的，规划和制造会导致显著的治疗延迟，使患者在等待期间面临破裂的风险。本报告的目的是描述使用新型开窗支架移植物治疗近/肾上动脉瘤的初步经验。
设计了一种带有两个肾开窗、一个 SMA 开窗和一个用于腹腔动脉的扇贝形开窗的开窗装置。肾动脉设计有一个 6mm 的内开窗和一个 15mm 的外直径，形成一个穹顶，允许进行各种肾动脉分布的肾动脉导管插入术。7 名具有复杂内脏动脉解剖结构的患者接受了包含这些枢轴肾开窗的定制支架移植物治疗。
技术成功率均为 100%，目标血管导管插入成功率为 100%，30 天死亡率为 0%。在一例中，移植物在输送过程中略有移位，导致术后 2 个月出现肾动脉支架闭塞。
改良开窗装置的开发表明这是可行的，它有可能减少广泛的术前移植物定制的需求，并为近肾和肾上 AAA 建立真正的现成平台。
