1 Department of Surgery, Vascular and Endovascular Surgery Unit "San Giovanni di Dio" Hospital, Florence, Italy.
J Endovasc Ther. 2018 Feb;25(1):62-67. doi: 10.1177/1526602817749309. Epub 2017 Dec 21.
To report bailout treatment of a thoracoabdominal aortic aneurysm using a single Nellix stent and parallel stents.
A 74-year-old man with multiple comorbidities and a previous fenestrated Anaconda stent-graft for a 60-mm juxtarenal aneurysm was diagnosed with a type IV thoracoabdominal aneurysm on the 2-year computed tomography angiography (CTA) scans. The imaging showed >10-mm downward migration of the proximal Anaconda stent with a massive type Ia endoleak and aneurysmal evolution of the distal descending thoracic aorta; the superior mesenteric artery (SMA) and renal artery covered stents were patent and intact. Open conversion or a second custom-made endograft was not feasible. A plan was devised to use off-the-shelf materials, including the deployment of a single Nellix stent extending from the descending thoracic aorta into the stented area of the fenestrated endograft, with parallel chimney stent-grafts into the SMA and right renal artery; the left renal artery was treated with a bare stent in a periscope configuration. Transient paraparesis was resolved with cerebrospinal fluid drainage. At 6-month CTA, ongoing aneurysm exclusion with patent SMA and renal arteries was confirmed.
Thoracic endovascular aneurysm sealing with visceral and renal stenting seems to be a feasible bailout alternative treatment for urgent, complex cases without reconstruction options.
报告使用单个 Nellix 支架和并行支架治疗胸腹主动脉瘤的抢救治疗情况。
一名 74 岁男性，患有多种合并症，曾因肾周动脉瘤行 Fenestrated Anaconda 支架移植物治疗，在 2 年的 CT 血管造影（CTA）扫描中诊断为 IV 型胸腹主动脉瘤。影像学检查显示近端 Anaconda 支架向下迁移超过 10mm，存在大量 Ia 型内漏，降胸主动脉远端发生动脉瘤样改变；肠系膜上动脉（SMA）和肾动脉覆盖的支架通畅且完整。开放转换或第二个定制的移植物支架不可行。制定了一个使用现成材料的计划，包括从降胸主动脉扩展到 Fenestrated 移植物支架区域的单个 Nellix 支架的部署，以及平行烟囱支架进入 SMA 和右肾动脉；左肾动脉采用望远镜构型的裸支架进行治疗。短暂性截瘫通过脑脊液引流得到解决。在 6 个月的 CTA 检查中，确认持续的动脉瘤排除，SMA 和肾动脉通畅。
对于没有重建选择的紧急复杂病例，胸主动脉腔内动脉瘤封闭加内脏和肾支架似乎是一种可行的抢救替代治疗方法。
