Treatment of Short-necked Infrarenal Aortic Aneurysms with Fenestrated Stent-grafts: Short-term Results
| Autor: | R.G. Hulsebos, C.J. Zeebregts, J.J.A.M. van den Dungen, Matthijs Oudkerk, E.L.G. Verhoeven, M.G. van Andringa de Kempenaer, I. F. J. Tielliu, R van Schilfgaarde, T. R. Prins |
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| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty Short neck medicine.medical_treatment Prosthesis Design Blood Vessel Prosthesis Implantation Aortic aneurysm Postoperative Complications Renal Artery medicine.artery Occlusion medicine Humans Stent-graft cardiovascular diseases Renal artery Aged Fixation (histology) Aged 80 and over Medicine(all) business.industry Stent Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure surgical procedures operative Abdomen Female Stents Radiology Cardiology and Cardiovascular Medicine business Fenestration Aortic Aneurysm Abdominal Follow-Up Studies Abdominal surgery |
| Zdroj: | European Journal of Vascular and Endovascular Surgery. 27(5):477-483 |
| ISSN: | 1078-5884 |
| DOI: | 10.1016/j.ejvs.2003.09.007 |
| Popis: | Introduction. A proximal neck of 15 mm length is usually required to allow endovascular repair of abdominal aortic aneurysms (EVAR). Many patients have been refused EVAR due to a short neck. By customising fenestrated grafts to the patients' anatomy, we can offer an endovascular solution, especially for patients who are unsuitable for open repair. Methods. Eighteen patients were selected for fenestrated stent-grafting if they presented with an abdominal aneurysm of at least 55 mm in diameter, a short neck (less than 15 mm), plus contra-indications for open repair (cardiopulmonary impairment or a hostile abdomen). The stent-graft used was a customised fenestrated model based on the Cook Zenith ® composite system. We used additional stents to ensure apposition of the fenestrations with the side branches. Results. All endovascular procedures were successful. Out of the 46 targeted side branches (10 superior mesenteric arteries, 36 renal arteries), 45 were patent at the end of the procedure. One accessory renal artery became occluded by the stent-graft. There was one possible proximal type I endoleak, which later proved to be a type II endoleak. There was no mortality, but complications occurred in six patients: two cardiac complications, three urinary complications and one occlusion of a renal artery. At follow-up (mean 9.4 months, range 1–18), there were no additional renal complications and all the remaining targeted vessels stayed patent. Discussion. By customizing fenestrated stent-grafts, it is possible to position the first covered stent completely inside the proximal neck, thus achieving a more stable position. The additional side-stents may also contribute to a better fixation. This technique may become a valuable alternative for patients who are at high risk from open surgery. |
| Databáze: | OpenAIRE |
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