1 Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
2 Division of Interventional Radiology and Vascular Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Endovasc Ther. 2018 Apr;25(2):237-241. doi: 10.1177/1526602818761663.
To report the use of the octopus endograft technique to treat a patient with a ruptured thoracoabdominal aortic aneurysm (TAAA).
A 46-year-old man was diagnosed with a contained rupture of a 9-cm type V TAAA. The presence of an occluded superior mesenteric artery (SMA), a stenotic celiac trunk, an enlarged inferior mesenteric artery (IMA), and rich collaterals with the SMA and celiac trunk made endovascular repair with the octopus endograft technique appear feasible. Two stent-grafts were overlapped in the thoracic aorta with the short limb of the distal bifurcated stent-graft about 3 cm above the celiac trunk and the long limb at the level of the renal arteries. A limb graft was introduced into the long limb of the bifurcated stent-graft and deployed with the lower end just above the orifice of the IMA. The celiac trunk was embolized. Viabahn stent-grafts were deployed through the bifurcated stent-graft limbs to revascularize the renal arteries. Completion angiography suggested free flow in the renal arteries, though the gutters around the Viabahn stent-grafts generated a moderate endoleak that persisted at 4-month follow-up. The gutters were then sealed with coil embolization, which eliminated the endoleak and induced complete thrombosis in the aneurysm sac at the 6-month follow-up. One-year computed tomography revealed significant sac shrinkage.
The octopus endograft technique may serve as a feasible, effective, and safe treatment alternative for highly selected patients with ruptured TAAA.
报告使用八爪鱼覆膜支架技术治疗一例胸主动脉腹主动脉瘤（TAAA）破裂患者的情况。
一名 46 岁男性被诊断为 9cm 型 V 胸主动脉腹主动脉瘤破裂，肠系膜上动脉（SMA）闭塞、腹腔干狭窄、肠系膜下动脉（IMA）增大，SMA 和腹腔干侧支循环丰富，因此采用八爪鱼覆膜支架技术进行腔内修复似乎可行。2 个覆膜支架在胸主动脉内重叠，远端分叉覆膜支架的短支位于腹腔干上方约 3cm，长支位于肾动脉水平。1 个分支支架被引入分叉覆膜支架的长支内，并在 IMA 开口上方展开。腹腔干被栓塞。Viabahn 覆膜支架通过分叉覆膜支架分支置入以重建肾动脉血流。完成血管造影显示肾动脉血流通畅，但 Viabahn 覆膜支架周围的“沟”产生中度内漏，在 4 个月随访时仍存在。然后用弹簧圈栓塞封闭“沟”，这消除了内漏，并在 6 个月随访时导致动脉瘤囊完全血栓形成。1 年后的 CT 显示瘤囊明显缩小。
对于高度选择的 TAAA 破裂患者，八爪鱼覆膜支架技术可能是一种可行、有效和安全的治疗选择。
