Department of Cardiovascular Surgery, Arizona Heart Institute, Phoenix, Arizona 85006, USA.
J Endovasc Ther. 2012 Dec;19(6):716-20. doi: 10.1583/JEVT-12-4038R.1.
To describe a bailout technique for in situ fenestration of an inadvertently covered internal iliac artery (IIA) associated with endovascular repair of an abdominal aortic aneurysm (AAA).
The procedure is demonstrated in a 76-year-old patient who underwent elective repair of a 5-cm infrarenal AAA using an Excluder endovascular graft 2 years following thoracic aortic stent-graft repair of a chronic type B aortic dissection. A completion angiogram demonstrated unintentional coverage of the left IIA. The iliac limb of the stent-graft was not able to be displaced away from the ostium, so to preserve IIA perfusion in a patient with prior thoracic aortic stent-grafting, a bailout technique was performed using an Outback re-entry device to successfully fenestrate the polytetrafluoroethylene graft material. An iCast balloon-expandable stent was placed across the fenestration creating a patent side branch to maintain patency. Six-year follow-up demonstrates a stable repair.
In situ fenestration of a stent-graft overlying the internal iliac artery can be a useful bailout technique when other options are unsuccessful.
描述一种用于腔内开窗修复意外覆盖的髂内动脉（IIA）的抢救技术，该技术与腹主动脉瘤（AAA）的血管内修复相关。
该手术在一名 76 岁的患者中进行，该患者在胸主动脉支架型人工血管修复慢性 B 型主动脉夹层 2 年后，因 5cm 以下腹主动脉 AAA 行择期修复。完成血管造影显示左侧 IIA 意外覆盖。支架型人工血管的髂支不能从开口处移位，因此为了在既往接受过胸主动脉支架型人工血管修复的患者中保留 IIA 灌注，采用 Outback 再进入装置进行抢救技术，成功地对聚四氟乙烯（PTFE）移植物进行开窗。放置 iCast 球囊可扩张支架穿过开窗，形成通畅的侧支以保持通畅。6 年随访显示修复稳定。
当其他方法不成功时，支架型人工血管覆盖髂内动脉的腔内开窗可以是一种有用的抢救技术。
