Pontificia Universidad Católica de Chile, Santiago, Chile.
Universitätsklinikum Hamburg Eppendorf Universitäres Herzzentrum Hamburg GmbH, Hamburg, Germany.
J Endovasc Ther. 2024 Aug;31(4):533-540. doi: 10.1177/15266028221134888. Epub 2022 Nov 7.
To describe a novel technique to repair a juxtarenal abdominal aortic aneurysm (JAAA) after failed endovascular aortic repair (EVAR) with severely kinked anatomy.
We present a patient who underwent an EVAR with a Medtronic Talent device 15 years ago and a proximal cuff extension 3 years earlier for an abdominal aortic aneurysm. Computed tomography (CT) done for a known gastritis showed a 12 cm JAAA, with a migrated endograft and a type Ia endoleak (EL). Endovascular repair was performed, accessing and navigating the aneurysmal sac outside the previous graft. The type I EL was reached and the suprarenal aorta catheterized. A 4-vessel inner-branched EVAR device was deployed in the distal thoracic aorta and their target vessels bridged through femoral access. A distal bifurcated component was deployed and both iliac limbs were extended to the native distal iliac arteries. Completion angiogram as well as early and 12-month CT showed a fully patent straight course branched EVAR with no ELs.
Complex aortic reinterventions in the presence of previous EVAR can be performed by choosing a straighter course along and parallel to the previous endograft. Several technical aspects must be considered to successfully perform this type of reinterventions.
We present a technique of a complex endovascular aortic repair in a failed EVAR with kinked anatomy, navigating through the thrombosed aneurysmal sac, outside the previously placed endograft and thus obtaining a straighter path for a new branched endograft. The novelty lies in a different approach to repair a failed EVAR with a branched graft through an uncommon access on the side of the previous endograft, avoiding repeated displacement or occlusion of the new endograft. We exemplify the feasibility of such a complex procedure and highlight important steps to perform it, whether in the abdominal or even thoracic Aorta.
描述一种修复因严重迂曲解剖而导致血管内修复（EVAR）失败的肾周腹主动脉瘤（JAAA）的新方法。
我们介绍了一位患者，他在 15 年前接受了 Medtronic Talent 装置的 EVAR 治疗，并在 3 年前因腹主动脉瘤进行了近端袖口延长术。因已知胃炎而行的计算机断层扫描（CT）显示 12cm JAAA，伴移植物内漏（EL）和 I 型。进行了血管内修复，进入并在先前的移植物外导航到动脉瘤囊。到达并在肾上主动脉内进行了导管操作。在远端胸主动脉内部署了一个 4 血管内分支 EVAR 装置，通过股动脉通路将其目标血管桥接。部署了一个远端分叉组件，并将两个髂肢延伸至原生的髂内动脉。完成的血管造影以及早期和 12 个月的 CT 显示完全通畅的直分支 EVAR，无 ELs。
在先前 EVAR 存在的情况下，复杂的主动脉再次干预可以通过选择沿先前移植物平行的更直的路径来完成。为了成功进行这种类型的再次干预，必须考虑几个技术方面。
我们提出了一种在迂曲解剖的 EVAR 失败后进行复杂血管内主动脉修复的技术，通过血栓形成的动脉瘤囊，在先前放置的移植物外进行导航，从而为新的分支移植物获得更直的路径。新颖之处在于通过先前移植物一侧的不常见入路，用分支移植物修复失败的 EVAR 的不同方法，避免新移植物的反复移位或闭塞。我们举例说明了这种复杂手术的可行性，并强调了进行这种手术的重要步骤，无论是在腹部甚至胸部主动脉。
