Paludetto Gustavo, Van der Meulen Stefaan, Ouriel Kenneth, Patarca Roberto
Division of Endovascular Surgery, Santa Lucia Hospital, Brasília, DF, Brazil.
Syntactx-Europe, Denderleeuw, Belgium.
EJVES Vasc Forum. 2021 Apr 18;51:9-12. doi: 10.1016/j.ejvsvf.2021.03.004. eCollection 2021.
Urgent or emergency treatment of patients with abdominal aortic aneurysms that are anatomically unsuitable for conventional repair because of short proximal necks, small diameters and access vessel calcification, and high risk for open repair can be performed with commercially available branched or fenestrated aortic endografts or physician modified stent grafts.
A technique is described for modification and successful implantation of a commercially available standard aortic stent graft with a low profile main body in two patients at high risk for open repair, with small access vessels and requiring uni- or bilateral renal artery fenestration for juxtarenal aneurysm repair.
Based on two case experiences, the use of physician modified off the shelf endografts appears to be a feasible and effective alternative to fenestrated endovascular repair in patients with juxtarenal abdominal aortic aneurysms at high risk for open surgical repair. Studies comparing effectiveness of the different options, including chimney/snorkel technique and debranching, are warranted.
对于因近端颈部短、直径小、入路血管钙化而解剖结构不适合传统修复且开放修复风险高的腹主动脉瘤患者，可使用市售的分支型或开窗型主动脉腔内移植物或医生改良的支架型人工血管进行紧急治疗。
描述了一种技术，用于在两名开放修复风险高、入路血管小且需要单侧或双侧肾动脉开窗以修复近肾动脉瘤的患者中，对市售的低轮廓主体标准主动脉支架型人工血管进行改良并成功植入。
基于两个病例经验，对于开放手术修复风险高的近肾腹主动脉瘤患者，使用医生改良的现成腔内移植物似乎是开窗血管内修复的一种可行且有效的替代方法。有必要开展研究比较不同方案（包括烟囱/ snorkel技术和去分支技术）的有效性。
