Unit of Vascular Surgery, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
Division of Vascular Interventional Radiology, Department of Diagnostic Imaging and Radiotherapy, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
J Endovasc Ther. 2024 Dec;31(6):1065-1070. doi: 10.1177/15266028231162259. Epub 2023 Mar 29.
We present the results of unconventional endovascular treatment of a voluminous (65 mm) saccular visceral aortic aneurysm in a 78-year-old woman. Patient was deemed unfit for open surgery due to comorbidities. Fenestrated or branched endografting was also excluded due to the small diameter of the aorta, the severe stenosis at the origin of celiac trunk, and the anomalous origin of superior mesenteric artery arising infrarenally.
After a preliminary selective angiography of the superior mesenteric artery showing valid anastomotic network with celiac trunk branches, an aortic self-expandable bare stent (Jotec E-XL) was deployed in the visceral aorta. Aneurysm sac embolization (Penumbra detachable Ruby Coils) in a coil-jailing technique was performed. Finally, an aortic cuff endograft (Gore) was deployed immediately above the origin of the left renal artery to cover the wide neck of the saccular aneurysm and improve sac exclusion. Hospital stay was uneventful, computed tomography (CT) at 12-month demonstrated aneurysm shrinkage to 62 mm without images of endoleak. Literature review showed how this technique has successfully been applied to manage similar cases of postsurgical and posttraumatic saccular aortic aneurysms in high-risk patients; however, long-term results are still unknown.
Coil-jail technique for the treatment of saccular aortic aneurysms can be considered an alternative when open surgery or conventional endovascular treatment is not feasible. Technical success and mid-term outcomes are promising but strict follow-up is recommended.
This study aims to share the unconventional endovascular treatment of a visceral aortic aneurysm in a patient unfit both for open and traditional endovascular surgery. To the best of our knowledge this is one of the first cases published in Literature, for this reason, a step-by-step video has been created to describe the procedure. Literature review was then performed to analyze midterm results of this technique. Despite being a treatment that is not recommended for conventional cases, the knowledge of endovascular devices and techniques may help to manage or simplify complex aortic diseases.
我们报告了一位 78 岁女性巨大（65 毫米）囊状内脏主动脉瘤的非常规血管内治疗结果。由于合并症，该患者不适合开放手术。由于主动脉直径小、腹腔干起始处严重狭窄以及肠系膜上动脉异常起源于肾下，也排除了覆膜支架开窗或分支型支架的可能性。
在肠系膜上动脉的初步选择性血管造影显示与腹腔干分支吻合良好的吻合网络后，在内脏主动脉内放置了自膨式裸支架（Jotec E-XL）。采用栓子捕获技术进行了动脉瘤囊栓塞（Penumbra 可解脱 Ruby 弹簧圈）。最后，在左肾动脉起源上方立即放置一个主动脉套袖移植物（戈尔），以覆盖囊状动脉瘤的宽颈并改善囊腔的隔离。住院期间无并发症，12 个月的 CT 显示动脉瘤缩小至 62 毫米，无内漏影像。文献复习表明，该技术已成功应用于管理高危患者的手术后和创伤后囊状主动脉瘤的类似病例，但长期结果仍未知。
对于无法进行开放手术或传统血管内治疗的患者，采用栓子捕获技术治疗囊状主动脉瘤可以作为一种替代方法。技术成功率和中期结果很有希望，但需要严格随访。
本研究旨在分享一位不适合开放和传统血管内手术的患者的内脏主动脉瘤的非常规血管内治疗。据我们所知，这是文献中首次报道的病例之一，因此，我们创建了一个分步视频来描述该过程。然后对该技术的中期结果进行了文献复习。尽管这种治疗方法不推荐用于常规病例，但对血管内器械和技术的了解可能有助于处理或简化复杂的主动脉疾病。
