Ito Eisaku, Ohki Takao, Toya Naoki, Nakagawa Hikaru, Nishide Ryou, Okazaki Kohei, Akiba Tadashi
Department of Vascular Surgery, The Jikei University Kashiwa Hospital, Kashiwa city, Chiba prefecture, Japan.
Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato City, Tokyo, 105-8471, Japan.
Surg Case Rep. 2021 Jan 31;7(1):36. doi: 10.1186/s40792-021-01115-9.
The snorkel technique for a juxtarenal abdominal aortic aneurysm (JAAA) is an important treatment option for high-risk patients. We report the lift snorkel technique through the trans-femoral access for a type Ia endoleak after fenestrated endovascular aneurysm repair (FEVAR) in a case of difficult trans-brachial access.
A 76-year-old woman who had JAAA presented with a type Ia endoleak and sac expansion after FEVAR. We planned for proximal additional stentgraft with the bilateral renal artery snorkel technique. However, during the secondary intervention, it was difficult to cannulate to the left renal artery through the trans-brachial access due to interference of the supra-renal stent. Stentgraft was eventually delivered into the left renal artery via the trans-femoral access with a 5 Fr sheath. A plain angioplasty balloon was inserted coaxially through the sheath. The balloon was inflated in the proximal end of the stentgraft and then pushed up to replace the proximal end from down to up. The additional aortic cuff was deployed parallel to the snorkel stentgraft. One year after the additional treatment, computed tomography (CT) revealed aneurysm sac shrinkage.
The lift snorkel technique is a unique method converting the retrograde approach to antegrade renal artery stenting and would be an effective option for difficult trans-brachial cases for a type Ia endoleak after FEVAR of a JAAA.
对于近肾腹主动脉瘤（JAAA），通气管技术是高危患者的重要治疗选择。我们报告了在经肱动脉入路困难的情况下，通过经股动脉入路对开窗型血管内动脉瘤修复术（FEVAR）后Ia型内漏采用升举通气管技术的情况。
一名患有JAAA的76岁女性在FEVAR后出现Ia型内漏和瘤囊扩张。我们计划采用双侧肾动脉通气管技术进行近端额外的支架移植物置入。然而，在二次干预过程中，由于肾上支架的干扰，经肱动脉入路难以将导管插入左肾动脉。最终通过经股动脉入路，使用5 Fr鞘管将支架移植物输送至左肾动脉。一个普通的血管成形术球囊通过鞘管同轴插入。球囊在支架移植物近端充气，然后向上推以由下向上替换近端。额外的主动脉袖带与通气管支架移植物平行展开。额外治疗一年后，计算机断层扫描（CT）显示动脉瘤囊缩小。
升举通气管技术是一种将逆行入路转换为顺行肾动脉支架置入的独特方法，对于JAAA的FEVAR术后Ia型内漏的经肱动脉困难病例将是一种有效的选择。
