D'Oria Mario, Griselli Filippo, Calvagna Cristiano, Lepidi Sandro
Division of Vascular and Endovascular Surgery, Cardio-Thoracic-Vascular Department, Integrated University Healthcare Giuliano-Isontina, University Hospital of Cattinara, Trieste, Italy.
Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
J Vasc Surg Cases Innov Tech. 2024 Nov 20;11(1):101688. doi: 10.1016/j.jvscit.2024.101688. eCollection 2025 Feb.
In the past 15 years, fenestrated-branched endovascular aortic repair (F-BEVAR) has progressively become the first-line option for management of most complex abdominal aortic aneurysms (AAAs); with increasing experience, as well as persistent technological refinements, F-BEVAR indications have been expanded to include rescue of failures after prior EVAR. Despite the feasibility and effectiveness, F-BEVAR procedures in the presence of prior infrarenal endografts may come with higher technical complexity that should be properly anticipated, and several anatomical challenges can be expected. Among these, presence of suprarenal bare stents from prior EVAR device are certainly a frequent scenario and may sometimes make target vessel cannulation more difficult because of encroachment on the target vessel origins. In this manuscript, we report a case intraoperative rescue of a dislodged renal stent during FEVAR for treatment of type 1 endoleak with the aim of showing the culprit of the complication, how to recognize it, and the off-label solution that was devised to solve it.
在过去15年中，开窗分支型血管腔内主动脉修复术（F-BEVAR）已逐渐成为大多数复杂腹主动脉瘤（AAA）治疗的一线选择；随着经验的增加以及技术的不断改进，F-BEVAR的适应证已扩大到包括挽救先前腔内血管修复术（EVAR）后的失败病例。尽管具有可行性和有效性，但在先前存在肾下腔内移植物的情况下进行F-BEVAR手术可能具有更高的技术复杂性，对此应进行适当预估，并且可以预期会出现一些解剖学上的挑战。其中，先前EVAR装置的肾上裸支架的存在肯定是一种常见情况，并且由于其对目标血管起源的侵犯，有时可能会使目标血管插管更加困难。在本手稿中，我们报告了一例在FEVAR治疗Ⅰ型内漏期间术中挽救移位肾支架的病例，目的是展示该并发症的罪魁祸首、如何识别它以及为解决该问题而设计的超适应证解决方案。
