Lee Sangho, Kim Hyeonju, Huh Seung, Kim Hyung-Kee
Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Front Surg. 2024 Dec 19;11:1518417. doi: 10.3389/fsurg.2024.1518417. eCollection 2024.
Current guidelines recommend preserving at least one of the bilateral pelvic flows in patients with aortoiliac aneurysms. The sandwich parallel graft, using commercially available devices, provides a viable option for patients who fall outside the instructions for use of iliac branch devices. However, gutter endoleak remains a significant challenge.
A 78-year-old woman with an incidentally discovered small AAA and bilateral CIAAs experienced aneurysmal growth to 42 mm for the abdominal aortic aneurysm (AAA) and 41 mm and 33 mm for the right and left common iliac artery aneurysms (CIAAs), respectively. Morphologic assessment of the aortoiliac aneurysm revealed the nearly 90-degree angles of the bilateral iliac bifurcations and the tortuous path of the internal iliac arteries. The iliac branch device was considered relatively contraindicated and ineligible; therefore, to preserve pelvic blood flow, the decision was made to employ the sandwich parallel graft technique in the left iliac arteries. Following the placement of the sandwich graft within the iliac limb, standard procedures were carried out. However, completion angiography revealed a type IA endoleak and a significant gutter endoleak in the left CIAA extending to the AAA sac. Despite the extension of overlapping zone, the gutter endoleak persisted after a 10 min waiting period. Therefore, we then advanced an 014 wire and a microcatheter to selectively access the gutter endoleak and performed embolization using multiple detachable coils. The final angiography showed complete resolution of the gutter endoleak and computed tomography angiography 1-month postoperatively confirmed the absence of any endoleaks.
This case report highlights that targeted embolization is a feasible and effective treatment for significant gutter endoleak following the sandwich parallel graft technique.
当前指南建议在治疗主髂动脉瘤患者时至少保留双侧盆腔血流中的一支。使用市售装置的三明治平行移植物为不符合髂支装置使用说明的患者提供了一种可行的选择。然而，肠沟内漏仍然是一个重大挑战。
一名78岁女性偶然发现小的腹主动脉瘤（AAA）和双侧髂总动脉瘤（CIAAs），腹主动脉瘤增长至42 mm，右侧和左侧髂总动脉瘤分别增长至41 mm和33 mm。主髂动脉瘤的形态学评估显示双侧髂动脉分叉近90度角以及髂内动脉走行迂曲。髂支装置被认为相对禁忌且不适用；因此，为了保留盆腔血流，决定在左髂动脉采用三明治平行移植物技术。在髂支内放置三明治移植物后，进行了标准操作。然而，完成血管造影显示左髂总动脉瘤存在IA型内漏和显著的肠沟内漏，延伸至腹主动脉瘤瘤腔。尽管重叠区域有所延长，但在等待10分钟后肠沟内漏仍然存在。因此，我们随后推进一根014导丝和一根微导管以选择性进入肠沟内漏部位，并使用多个可脱卸弹簧圈进行栓塞。最终血管造影显示肠沟内漏完全消失，术后1个月的计算机断层扫描血管造影证实无任何内漏。
本病例报告强调，靶向栓塞是三明治平行移植物技术后严重肠沟内漏的一种可行且有效的治疗方法。
