Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
J Vasc Surg. 2012 Aug;56(2):538-41. doi: 10.1016/j.jvs.2012.03.022. Epub 2012 Jun 15.
We describe a case of a type IIIb endoleak arising from the main body of a Talent endograft that was treated using two telescoping cuffs and two parallel upside-down inserted Excluder contralateral legs, thereby creating a new bifurcating endograft. First, a 23-mm cuff was deployed onto the flow divider of the Talent endograft, followed by a second 28-mm cuff below the renal arteries creating a tapering lumen. Two 20-mm Excluder contralateral limbs were then positioned upside-down in the 23-mm cuff and deployed simultaneously, creating a new bifurcated prosthesis. Control computed tomography (CT) scan at 6 weeks showed a good position of the endografts without signs of an endoleak. In conclusion, a type IIIb endoleak at the level of the flow divider may successfully be excluded using two telescoping cuffs and two parallel upside-down contralateral Excluder limbs. Due to the rarity of this complication, the treatment will always have to be tailor-made.
我们描述了一例源自 Talent 血管内移植物主体的 IIIb 型内漏，该内漏采用两个可伸缩袖套和两个平行倒置的 Excluder 对侧支腿进行治疗，从而创建了一个新的分叉血管内移植物。首先，将 23mm 袖套部署到 Talent 血管内移植物的分流器上，然后在肾动脉下方部署第二个 28mm 袖套，形成一个逐渐变细的管腔。然后将两个 20mm 的 Excluder 对侧支腿倒置放置在 23mm 袖套中并同时部署，创建一个新的分叉假体。6 周时的控制计算机断层扫描（CT）显示内植物位置良好，没有内漏迹象。总之，使用两个可伸缩袖套和两个平行倒置的对侧 Excluder 支腿可以成功排除血流分隔器水平的 IIIb 型内漏。由于这种并发症较为罕见，治疗方法必须始终根据具体情况而定。
