医学
肠系膜上动脉
支架
管腔(解剖学)
动脉瘤
形状记忆合金*
放射科
解剖(医学)
腔内修复术
袖口
腹主动脉瘤
外科
主动脉瘤
数学
组合数学
作者
Alexander D. DiBartolomeo,Elizabeth Miranda,Alyssa J. Pyun,Gregory A. Magee,Kenneth R. Ziegler,Jacquelyn K. Paige,Sukgu M. Han
标识
DOI:10.1177/15266028231188857
摘要
Purpose: Long-segment aortic branch dissections have been considered a relative contraindication for fenestrated-branched endovascular aneurysm repair (FB-EVAR). This case report describes a technique of dual-lumen stenting of a fully-dissected superior mesenteric artery (SMA) to preserve patency of the true and false lumens during FB-EVAR. Case Report: A 67-year-old man presented with a 6.0 cm extent III chronic post-dissection thoracoabdominal aortic aneurysm. The patient had highly-complex anatomy including dissection of the entire SMA. The true and false lumens of the dissected SMA were noted to be supplying different branches, requiring preservation of both lumens. The patient underwent a staged physician-modified FB-EVAR. A modified endograft containing 5 fenestrations and 1 branch cuff was introduced and the celiac, true-lumen SMA, and 3 renal arteries were sequentially catheterized using staggered deployment of the modified endograft. The false lumen SMA stent was catheterized via the branch cuff. Molded parallel grafting (“eye-of-the-tiger”) technique was used to achieve double D configuration between the true and false lumens of the SMA. Conclusion: This case demonstrates feasibility of dual-lumen stenting to incorporate dissected target vessels during FB-EVAR while preserving flow to both the true and false lumens and the second-order branches they supply. Clinical Impact We report a novel technique that allows incorporation of branch vessels affected by long segment dissection during fenestrated branched endovascular aortic repairs. This has potential advantage of preserving flow to all secondary branches of the dissected target vessels, while reducing the risk of type Ic endoleak.
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