Georgakarakos Efstratios, Argyriou Christos, Schoretsanitis Nikolaos, Georgiadis George S
Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
Ann Vasc Surg. 2017 Feb;39:291.e15-291.e19. doi: 10.1016/j.avsg.2016.08.018. Epub 2016 Nov 28.
To describe the use of the combination of a conical custom-made TREO (TREO CM) stent graft in the treatment of a saccular abdominal aortic endograft (AAA) with long but tight and calcified distal neck.
A 65-year-female patient was treated for a saccular 5.2 cm AAA with a 3-cm long but calcified and tight (16 mm) distal neck, precluding the safe use of a bifurcated endograft. Because the patient refused an open surgery, a conical TREO CM endograft was manufactured with 20% proximal oversizing, whereas the 3-cm caudal sealing segment demonstrated a conical configuration comprising a 2-cm and 1-cm nitinol-supported zones of 20% and 10% oversizing, respectively, to avoid excessive strain and incomplete expand at the most distal calcified area, leading ultimately to an insidious infolding and consequent type Ib endoleak. A 24 × 40 mm Treovance aortic cuff was centrally deployed resulting in a 30 mm overlap with the main endograft.
After 6 months, there was complete sealing, and the AAA sac has been shrunk to 45 mm.
The use of a conical TREO CM endograft with a proximal cuff provides a firm fixation centrally and a sufficient distal sealing design in AAAs with calcified and tight distal aorta, constituting a reliable alternative to bifurcated endografts or aortouniliac configurations followed by crossover adjuncts.
描述使用定制的锥形TREO（TREO CM）支架型人工血管治疗伴有长且狭窄钙化远端颈部的囊状腹主动脉瘤（AAA）。
一名65岁女性患者接受治疗，其患有直径5.2 cm的囊状AAA，远端颈部长度为3 cm，但钙化且狭窄（16 mm），无法安全使用分叉型人工血管。由于患者拒绝接受开放手术，因此制作了一个近端放大20%的锥形TREO CM人工血管，而3 cm的尾端密封段呈锥形结构，分别包括2 cm和1 cm的镍钛诺支撑区，放大比例分别为20%和10%，以避免在最远端钙化区域出现过度应变和不完全扩张，最终导致隐匿性内折及随之而来的Ib型内漏。将一个24×40 mm的Treovance主动脉袖套置于中心位置，使其与主人工血管有30 mm的重叠。
6个月后，实现了完全密封，AAA瘤腔已缩小至45 mm。
使用带有近端袖套的锥形TREO CM人工血管可在中心提供牢固固定，并在远端主动脉钙化且狭窄的AAA中提供充分的远端密封设计，是分叉型人工血管或主动脉单髂型结构加交叉辅助装置的可靠替代方案。
