Aho Pekka-Sakari, Björkman Patrick, Venermo Maarit
Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
Division of Vascular Surgery, Meilahti Tower Hospital, Helsinki, Finland.
J Vasc Surg Cases Innov Tech. 2024 Feb 12;10(3):101452. doi: 10.1016/j.jvscit.2024.101452. eCollection 2024 Jun.
Renal artery access might not always be achieved due to anatomical reasons during the deployment of a branched stent graft in thoracoabdominal or juxtarenal abdominal aortic aneurysms. Renal perfusion is maintained through the aneurysm sac until the iliac limbs are deployed. To preserve renal perfusion, a branched iliac limb would be needed. Such limbs with a side branch, a narrow (12-14 mm) proximal end, and a wide (16-20 mm) distal end are not commercially available. Due to the nature of their deployment mechanism, Gore Excluder distal limbs (W.L. Gore & Associates) have been used outside the instructions for use in reversed position. A traditional Gore Excluder main body can be reversed; however, the smallest proximal diameter is 23 mm, which could be too large to be deployed in a typically 16- to 18-mm common iliac artery. However, the smallest Gore Excluder Conformable endoprosthesis (W.L. Gore & Associates, Inc) main body is 20 mm in diameter, and the distal limb is 14.5 mm. This allows for a perfect fit when deployed in reversed position between an 11-mm unibody limb (Cook Medical Inc) and the common iliac artery, resulting in access to the renal artery from the side branch. We used a Gore Excluder Conformable main body graft in two such cases successfully. In these two patients, the iliac limbs and renal artery have stayed patent during a follow-up of 24 and 3 months. A Gore Excluder Conformable graft can be deployed in reversed position, using it as a conduit between the branched stent graft limb, common iliac artery, and renal artery.
在胸腹主动脉瘤或近肾腹主动脉瘤中部署分支覆膜支架时，由于解剖学原因，可能无法始终实现肾动脉入路。在髂支展开之前，通过瘤腔维持肾脏灌注。为了保持肾脏灌注，需要一个分支髂支。这种带有侧支、近端狭窄（12 - 14毫米）和远端宽阔（16 - 20毫米）的髂支并无商业产品。由于其展开机制的特性，戈尔（Gore）Excluder远端髂支（W.L. Gore & Associates公司）已在超出使用说明的情况下以倒置位置使用。传统的戈尔Excluder主体可以倒置；然而，其最小近端直径为23毫米，对于通常直径为16至18毫米的髂总动脉来说可能太大而无法展开。然而，最小的戈尔Excluder顺应性腔内修复装置（W.L. Gore & Associates公司）主体直径为20毫米，远端髂支为14.5毫米。当在11毫米一体式髂支（库克医疗公司）和髂总动脉之间以倒置位置展开时，这能实现完美贴合，从而通过侧支进入肾动脉。我们成功地在两例此类病例中使用了戈尔Excluder顺应性主体移植物。在这两名患者中，在24个月和3个月的随访期间，髂支和肾动脉保持通畅。戈尔Excluder顺应性移植物可以以倒置位置展开，用作分支覆膜支架髂支、髂总动脉和肾动脉之间的管道。
