Ertugay Serkan, Daylan Ahmet, Bozkaya Halil, Oğuz Emrah, Apaydın Anıl, Parıldar Mustafa, Posacıoğlu Hakan
1 Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey.
2 Department of Radiology, Ege University School of Medicine, Izmir, Turkey.
Vasc Endovascular Surg. 2018 Apr;52(3):233-236. doi: 10.1177/1538574418758597. Epub 2018 Feb 12.
The snorkel technique is commonly used to preserve renal arteries in juxta renal aneurysm during endovascular repair. Herein, we present a patient who underwent bifurcated endograft implantation with snorkel technique for inferior mesenteric artery (IMA) in order to preserve the major source of bowel circulation.
A 69-year-old male patient was diagnosed with abdominal aortic aneurysm. His history revealed that he had bowel resection due to a car accident 30 years ago. In addition, he was given relaparotomy 4 times due to intestinal complications. Computed tomography showed fusiform aneurysm with a maximal diameter of 60 mm and chronical occlusion of the superior mesenteric artery. Inferior mesenteric artery was found to be hypertrophic. During EVAR, 6 mm × 10 cm covered VIABAHN Endoprosthesis (Gore Medical) was implanted to the IMA over a 0.018 guidewire via puncture of the left axillary artery. Initially, the main body of the aortic stent-graft (Gore C3, size 23-14-16) was implanted to the infra renal segment of the aorta (below the renal arteries and the orifice using VIABAHN) via the right femoral artery. Next, the contralateral leg (Gore, 14-12-00) was implanted. Computed tomography was examined at 1- and 32-month postoperatively, and no endoleak or patency of IMA stent was detected.
In this case of IMA-dependent circulation of the intestinal system, the protection of IMA via snorkel technique was successful.
在血管腔内修复近肾动脉瘤时，常用通气管技术来保留肾动脉。在此，我们报告一例患者，其接受了采用通气管技术的分叉型血管内移植物植入术以保留肠系膜下动脉（IMA），从而保留肠道循环的主要来源。
一名69岁男性患者被诊断为腹主动脉瘤。他的病史显示30年前因车祸接受过肠道切除术。此外，由于肠道并发症他还接受了4次再次剖腹手术。计算机断层扫描显示为梭形动脉瘤，最大直径为60 mm，肠系膜上动脉慢性闭塞。发现肠系膜下动脉肥厚。在血管腔内修复主动脉瘤（EVAR）过程中，通过穿刺左腋动脉，在0.018导丝引导下将6 mm×10 cm的VIABAHN覆膜内支架（戈尔医疗公司）植入IMA。最初，通过右股动脉将主动脉覆膜支架移植物的主体（戈尔C3型，尺寸为23 - 14 - 16）植入主动脉肾下段（在肾动脉及使用VIABAHN的开口下方）。接下来，植入对侧分支（戈尔，14 - 12 - 00）。术后1个月和32个月进行计算机断层扫描检查，未检测到内漏或IMA支架通畅情况。
在这种肠道系统依赖IMA循环的病例中，通过通气管技术成功保护了IMA。
