Department for Vascular Medicine, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
J Endovasc Ther. 2013 Jun;20(3):289-94. doi: 10.1583/13-4231R.1.
To report the use of antegrade in situ fenestration as a bailout technique to rescue a renal artery after inadvertent coverage during endovascular aneurysm repair (EVAR).
The technique is demonstrated in a patient with a 6-cm infrarenal abdominal aortic aneurysm (AAA) and a short, angulated proximal neck. A type I endoleak persisted on completion angiography after implantation of a bifurcated Zenith stent-graft despite dilation with a compliant balloon. A Giant Palmaz stent mounted on a large compliant balloon successfully resolved the endoleak. After placing the stent, the left renal artery was covered completely by the main aortic graft material, leading to only marginal opacification on angiography. To preserve flow to the renal artery, a transseptal sheath and transseptal needle were introduced from the right femoral artery and used to puncture the abdominal stent-graft antegrade at the site of the left renal artery. A 0.018-inch guidewire could then be introduced into the left renal artery; following a number of maneuvers, a balloon-expandable stent was placed through the fenestration into the target vessel. On computed tomographic angiography 4 days postoperatively, the AAA remained excluded and both renal arteries were patent, with all side branches fully preserved. Renal function was completely restored.
Antegrade in situ fenestration can facilitate immediate revascularization of inadvertently covered side branches in EVAR using a transseptal sheath and needle. If the anatomical features are supportive, antegrade in situ fenestration can be a useful bailout technique.
报告使用顺行原位开窗技术作为血管内修复（EVAR）过程中肾动脉意外覆盖的抢救技术。
在一名 6cm 下腹部腹主动脉瘤（AAA）和短而倾斜的近端颈部患者中演示了该技术。尽管使用顺应性球囊进行了扩张，但在植入分叉 Zenith 支架移植物后完成的血管造影仍显示存在 I 型内漏。一个安装在大顺应性球囊上的 Giant Palmaz 支架成功解决了内漏问题。放置支架后，左肾动脉完全被主主动脉移植物材料覆盖，导致血管造影时仅边缘显影。为了保留肾动脉的血流，从右股动脉引入了一个跨隔鞘和跨隔针，用于在左肾动脉处顺行穿刺腹主动脉支架移植物。然后可以将 0.018 英寸的导丝引入左肾动脉; 经过多次操作，将球囊扩张支架通过开窗放置到目标血管中。术后 4 天的 CT 血管造影显示，AAA 仍然被排除，并且双侧肾动脉均通畅，所有侧支均完全保留。肾功能完全恢复。
顺行原位开窗技术可以使用跨隔鞘和针迅速重建意外覆盖的 EVAR 侧支。如果解剖特征支持，顺行原位开窗技术可以作为一种有用的抢救技术。
