1. Branched Endovascular Aortic Repair After a Migrated EVAR Bypassing a Severely Kinked Previous Endograft.
- Author
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Torrealba JI, Kölbel T, Rohlffs F, Spanos K, and Panuccio G
- Subjects
- Humans, Male, Treatment Outcome, Reoperation, Aged, Computed Tomography Angiography, Prosthesis Failure, Treatment Failure, Aged, 80 and over, Endovascular Aneurysm Repair, Endovascular Procedures instrumentation, Endovascular Procedures adverse effects, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Blood Vessel Prosthesis Implantation adverse effects, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Abdominal diagnostic imaging, Prosthesis Design, Foreign-Body Migration etiology, Foreign-Body Migration diagnostic imaging, Foreign-Body Migration surgery, Endoleak etiology, Endoleak diagnostic imaging, Endoleak surgery, Aortography, Stents
- Abstract
Purpose: To describe a novel technique to repair a juxtarenal abdominal aortic aneurysm (JAAA) after failed endovascular aortic repair (EVAR) with severely kinked anatomy., Technique: We present a patient who underwent an EVAR with a Medtronic Talent device 15 years ago and a proximal cuff extension 3 years earlier for an abdominal aortic aneurysm. Computed tomography (CT) done for a known gastritis showed a 12 cm JAAA, with a migrated endograft and a type Ia endoleak (EL). Endovascular repair was performed, accessing and navigating the aneurysmal sac outside the previous graft. The type I EL was reached and the suprarenal aorta catheterized. A 4-vessel inner-branched EVAR device was deployed in the distal thoracic aorta and their target vessels bridged through femoral access. A distal bifurcated component was deployed and both iliac limbs were extended to the native distal iliac arteries. Completion angiogram as well as early and 12-month CT showed a fully patent straight course branched EVAR with no ELs., Conclusion: Complex aortic reinterventions in the presence of previous EVAR can be performed by choosing a straighter course along and parallel to the previous endograft. Several technical aspects must be considered to successfully perform this type of reinterventions., Clinical Impact: We present a technique of a complex endovascular aortic repair in a failed EVAR with kinked anatomy, navigating through the thrombosed aneurysmal sac, outside the previously placed endograft and thus obtaining a straighter path for a new branched endograft. The novelty lies in a different approach to repair a failed EVAR with a branched graft through an uncommon access on the side of the previous endograft, avoiding repeated displacement or occlusion of the new endograft. We exemplify the feasibility of such a complex procedure and highlight important steps to perform it, whether in the abdominal or even thoracic Aorta., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Tilo Kölbel: Consultant, proctoring, IP, royalties, research, and travel grants with Cook Medical.
- Published
- 2024
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