DiBartolomeo Alexander D, Miranda Elizabeth, Pyun Alyssa J, Magee Gregory A, Ziegler Kenneth R, Paige Jacquelyn, Han Sukgu M
Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of University of Southern California, Los Angeles, CA, USA.
J Endovasc Ther. 2023 Jul 29:15266028231188857. doi: 10.1177/15266028231188857.
Long-segment aortic branch dissections have been considered a relative contraindication for fenestrated-branched endovascular aneurysm repair (FB-EVAR). This case report describes a technique of dual-lumen stenting of a fully-dissected superior mesenteric artery (SMA) to preserve patency of the true and false lumens during FB-EVAR.
A 67-year-old man presented with a 6.0 cm extent III chronic post-dissection thoracoabdominal aortic aneurysm. The patient had highly-complex anatomy including dissection of the entire SMA. The true and false lumens of the dissected SMA were noted to be supplying different branches, requiring preservation of both lumens. The patient underwent a staged physician-modified FB-EVAR. A modified endograft containing 5 fenestrations and 1 branch cuff was introduced and the celiac, true-lumen SMA, and 3 renal arteries were sequentially catheterized using staggered deployment of the modified endograft. The false lumen SMA stent was catheterized via the branch cuff. Molded parallel grafting ("eye-of-the-tiger") technique was used to achieve double D configuration between the true and false lumens of the SMA.
This case demonstrates feasibility of dual-lumen stenting to incorporate dissected target vessels during FB-EVAR while preserving flow to both the true and false lumens and the second-order branches they supply.
We report a novel technique that allows incorporation of branch vessels affected by long segment dissection during fenestrated branched endovascular aortic repairs. This has potential advantage of preserving flow to all secondary branches of the dissected target vessels, while reducing the risk of type Ic endoleak.
长节段主动脉分支夹层一直被认为是开窗分支型血管腔内动脉瘤修复术（FB-EVAR）的相对禁忌证。本病例报告描述了一种对完全夹层的肠系膜上动脉（SMA）进行双腔支架置入的技术，以在FB-EVAR期间保持真腔和假腔的通畅。
一名67岁男性，患有6.0 cm的Ⅲ型慢性夹层后胸腹主动脉瘤。患者解剖结构高度复杂，包括整个SMA夹层。发现夹层SMA的真腔和假腔供应不同的分支，需要保留两个腔。患者接受了分期的医生改良FB-EVAR。引入了一个包含5个开窗和1个分支袖套的改良血管内移植物，并使用改良血管内移植物的交错部署依次对腹腔干、真腔SMA和3支肾动脉进行插管。通过分支袖套对假腔SMA支架进行插管。采用模制平行移植（“虎眼”）技术在SMA的真腔和假腔之间实现双D构型。
本病例证明了在FB-EVAR期间对夹层靶血管进行双腔支架置入以保留真腔和假腔及其供应的二级分支血流的可行性。
我们报告了一种新技术，该技术允许在开窗分支型血管腔内主动脉修复术中纳入受长节段夹层影响的分支血管。这具有保留夹层靶血管所有二级分支血流的潜在优势，同时降低Ic型内漏的风险。
