Endovascular repair of abdominal aortic aneurysm with severely angulated neck and tortuous artery access: case report and literature review

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• 作者：Qinglong Zeng ; Lianjun Huang ; Xiaoyong Huang ; Mingliang Peng
• 关键词：Abdominal aortic aneurysm ; Hostile neck ; Endovascular aneurysm repair
• 刊名：BMC Surgery
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：15
• 期：1
• 全文大小：2,390 KB
• 参考文献：1. Prinssen, M, Verhoeven, EL, Buth, J, Cuypers, PW, Sambeek, MR, Balm, R, Buskens, E, Grobbee, DE, Blankensteijn, JD (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351: pp. 1607-1618 CrossRef
  2. Greenhalgh, RM, Brown, LC, Kwong, GP, Powell, JT, Thompson, SG (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364: pp. 843-848 CrossRef
  3. Stather, PW, Sayers, RD, Cheah, A, Wild, JB, Bown, MJ, Choke, E (2012) Outcomes of endovascular aneurysm repair in patients with hostile neck anatomy. Eur J Vasc Endovasc Surg 44: pp. 556-561 CrossRef
  4. Matsumoto T, Tanaka S, Okadome J, Kyuragi R, Fukunaga R, Kawakubo E, Itoh H, Okazaki J, Shirabe K, Fukuda A. Midterm outcomes of endovascular repair for abdominal aortic aneurysms with the on-label use compared with the off-label use of an endoprosthesis. Surg Today 2014. (Epub)
  5. Weale, AR, Beckitt, T, Collin, N, Hardman, J (2012) Evidence for endovascular aneurysm repair in patients with highly angulated neck anatomy. J Cardiovasc Surg (Torino) 53: pp. 433-445
  6. Scarcello, E, Serra, R, Morrone, F, Tarsitano, S, Triggiani, G, Franciscis, S (2012) Aortic banding and endovascular aneurysm repair in a case of juxtarenal aortic aneurysm with unsuitable infrarenal neck. J Vasc Surg 56: pp. 208-211 CrossRef
  7. Vries, JP (2012) The proximal neck: the remaining barrier to a complete EVAR world. Semin Vasc Surg 25: pp. 182-186 CrossRef
  8. Bischoff, MS, Peters, AS, Meisenbacher, K, Bockler, D (2014) Challenging access in endovascular repair of infrarenal aortic aneurysms. J Cardiovasc Surg (Torino) 55: pp. 75-83
  9. Duffy, JM, Rolph, R, Clough, RE, Modarai, B, Taylor, P, Waltham, M (2013) Stent graft types for endovascular repair of abdominal aortic aneurysms. Cochrane Database Syst Rev 3:
  10. Parodi, JC, Palmaz, JC, Barone, HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5: pp. 491-499 CrossRef
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  12. Albertini, JNPT, Soong, CV, Hinchliffe, RJ, Trojanowska, M, Yusuf, SW (2006) Endovascular repair of abdominal aortic aneurysms in patients with severe angulation of the proximal neck using a flexible stent-graft European: Multicenter Experience. J Cardiovasc Surg (Torino) 47: pp. 245-250
  13. Igari, K, Kudo, T, Toyofuku, T, Jibiki, M, Inoue, Y (2014) Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use. Ann Thorac Cardiovasc 20: pp. 61-66 CrossRef
  14. Hobo, R, Kievit, J, Leurs, LJ, Buth, J (2007) Influence of severe infrarenal aortic neck angulation on complications at the proximal neck following endovascular AAA repair: A EUROSTAR study. J Endovasc Ther 14: pp. 1-11 CrossRef
  15. Ishibashi, H, Ishiguchi, T, Ohta, T, Sugimoto, I, Yamada, T, Tadakoshi, M, Hida, N, Orimoto, Y (2012) Remodeling of proximal neck angulation after endovascular aneurysm repair. J Vasc Surg 56: pp. 1201-1205 CrossRef
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  17. Pavlidis,
• 刊物主题：Surgery; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1471-2482

文摘

Background Endovascular aneurysm repair has revolutionized the therapeutic strategy for abdominal aortic aneurysm. However, hostile proximal aneurysmal neck and tortuosity of access vessels remain challenges in selecting optimal stent-grafts in abdominal aortic aneurysms with difficult anatomy. Case presentation A 65-year-old woman complained of intermittent abdominal pain for one week. Computed tomography angiogram demonstrated a tortuous infrarenal abdominal aortic aneurysm with a tapered neck and a 136° of infrarenal angulation. Aneurysmal dilatation and severe calcification of bilateral iliac arteries and tortuous aortoiliac access were also showed. Endovascular approach using Endurant stent-graft was attempted at an outside hospital, but failed because of the significant tortuosity of the abdominal aorta and iliac arteries. Since the patient refused to have open aneurysm repair, he was transferred to our hospital for further evaluation and possible EVAR with a different approach. EVAR was performed successfully using Gore Excluder stent-grafts (W.L. Gore & Associates, Flagstaff, AZ, USA). During the procedure, cannulation of the contralateral limb was unable to be achieved because of the tortuous aortoiliac course. Therefore, a snare was inserted from right radial artery, through the contralateral gate, to grasp the wire from left femoral artery. Two iliac stent-grafts were sequentially deployed with the lower end distal to the opening of the left internal iliac artery. Angiography confirmed complete sealing of the aneurysm with patency of bilateral renal arteries and external iliac arteries. The postoperative courses were uneventful and follow-up computed tomography angiogram at 6?months demonstrated patent bilateral femoral and renal arteries without endoleaks or stent migration. Conclusion Although endovascular repair of aortic aneurysm with hostile neck and tortuous access is rather challenging, choosing flexible stent-grafts and suitable techniques is able to achieve an encouraging outcome.