Sule J A, Dharmaraj R B
Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore.
EJVES Short Rep. 2016 May 9;32:7-11. doi: 10.1016/j.ejvssr.2016.03.007. eCollection 2016.
Endovascular repair of suprarenal abdominal aortic aneurysms (AAAs) requires customized fenestrated stent grafts when they involve visceral vessels such as the renal (clinically ignored here in this specific scenario), celiac, and superior mesenteric arteries.
On table fenestrated endovascular abdominal aortic aneurysm repair (F-EVAR), using a parallel endograft approach, was performed for enlarging saccular subacute mycotic suprarenal and left common iliac artery aneurysms in a 58 year old man with recent methicillin sensitive (MSSA) bacteremia, who was high risk for open surgical repair. Fenestrations were performed for the coeliac artery (CA) and superior mesenteric artery (SMA) using a Bovie (Clearwater, FL, USA) cautery device. The initial procedure was complicated by a type II endoleak that resolved spontaneously within 6 months of surgery. The patient remained well on follow up a year post surgery.
On table surgeon modified F-EVAR is a safe and viable option for patients with subacute suprarenal mycotic abdominal aneurysms.
当肾上腹主动脉瘤（AAA）累及诸如肾动脉（在本特定情况下临床上对此忽略）、腹腔干和肠系膜上动脉等内脏血管时，其血管腔内修复需要定制开窗支架移植物。
对一名58岁近期患有甲氧西林敏感（MSSA）菌血症且开放手术修复风险高的男性患者，采用平行移植物入路，在术中进行开窗血管腔内腹主动脉瘤修复（F-EVAR），以治疗逐渐增大的囊状亚急性霉菌性肾上和左髂总动脉瘤。使用博维电刀（美国佛罗里达州克利尔沃特）为腹腔干（CA）和肠系膜上动脉（SMA）进行开窗。初始手术因II型内漏而复杂化，该内漏在术后6个月内自发消失。患者术后一年随访情况良好。
术中外科医生改良的F-EVAR对于患有亚急性霉菌性肾上腹主动脉瘤的患者是一种安全可行的选择。
