Endovascular Neck Stabilization Before EVAR for Infrarenal Aortic Aneurysm in Chronic Aortic Dissection

Journal Article · Tue Oct 15 04:00:00 EDT 2019 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-019-02277-8· OSTI ID:22970603

Ogawa, Yukihisa ^[1]; Nishimaki, Hiroshi ^[2]; Iraha, Tomotaka ^[1]; Itoga, Nathan K. ^[3]; Chiba, Kiyoshi; Kotoku, Akiyuki ^[1]; Maruhashi, Takaaki ^[4]; Mimura, Hidefumi ^[1]; Watkins, Amelia Claire ^[5]; Miyairi, Takeshi ^[2]

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1. St. Marianna University School of Medicine, Department of Radiology (Japan)
2. St. Marianna University School of Medicine, Department of Cardiovascular Surgery (Japan)
3. Stanford University School of Medicine, Division of Vascular Surgery (United States)
4. Kitasato University School of Medicine, Department of Emergency and Critical Care Medicine (Japan)
5. Stanford University School of Medicine, Department of Cardiothoracic Surgery (United States)

Background: Endovascular treatment of infrarenal abdominal aortic aneurysm (AAA) with proximal chronic aortic dissection is challenging as a false and true lumen at the level of the infra-renal neck does not allow a sufficient landing zone. We describe staged endovascular neck stabilization prior to standard endovascular aortic repair (EVAR) for AAA with chronic aortic dissection. Technique: To create a stable proximal neck (PN) by closing entry tears, thereby resulting in total false lumen thrombosis (FLT) prior to standard EVAR. Case 1 false lumen fenestrations were present at the descending aorta, the right renal artery orifice and PN. After closing the entry tear by thoracic EVAR, an aortic cuff was placed in the true lumen of the PN and renal stenting for the right renal artery was performed. After 2 months, total FLT was achieved, and EVAR was performed. Case 2 false lumen fenestrations were present at the descending, super celiac aorta and PN. After closing the entry by TEVAR, aortic cuffs were placed at infrarenal aorta to close residual entries. After 1 month of achieving total FLT, EVAR was performed. Both cases had no type 1 endoleak during follow-up. Conclusion: The endovascular neck stabilization is a useful treatment option that facilitates standard EVAR for AAA in chronic aortic dissection.

• OSTI ID: 22970603
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 10 Vol. 42; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
AORTA
BIOLOGICAL REPAIR
KIDNEYS
NECK
ORIFICES
STABILIZATION
THROMBOSIS