Early experience with the snorkel technique for juxtarenal aneurysms

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Presentation transcript:

Early experience with the snorkel technique for juxtarenal aneurysms Jason T. Lee, MD, Joshua I. Greenberg, MD, Ronald L. Dalman, MD Journal of Vascular Surgery Volume 55, Issue 4, Pages 935-946 (April 2012) DOI: 10.1016/j.jvs.2011.11.041 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 Current algorithm for surgical and endovascular management of juxtarenal abdominal aortic aneurysms (JAAAs). IDE, Investigational device exemption; SMA, superior mesenteric artery. Journal of Vascular Surgery 2012 55, 935-946DOI: (10.1016/j.jvs.2011.11.041) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Anteroposterior (AP) and (B) lateral views of snorkel setup with bilateral iCAST stents positioned in the renal artery origins. This juxtarenal aneurysm had significant infrarenal thrombus precluding an adequate proximal seal with a standard device. The arrow that signifies the most proximal portion of the fabric of the endograft immediately deployed to the level of the superior mesenteric artery to maximize endograft neck apposition. Journal of Vascular Surgery 2012 55, 935-946DOI: (10.1016/j.jvs.2011.11.041) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Deliberate “triple-kissing” balloon angioplasty for double-renal snorkel case, with renal balloons inflated (B) while molding endograft balloon is inflated (C) and then deflated (D). Journal of Vascular Surgery 2012 55, 935-946DOI: (10.1016/j.jvs.2011.11.041) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Crossing pattern (A) seen of most covered stents creating gutter (B) and indenting the main body of the endograft in follow-up (C). Journal of Vascular Surgery 2012 55, 935-946DOI: (10.1016/j.jvs.2011.11.041) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 5 A, Kinked left renal snorkel iCAST stent (arrow), without flow abnormality (B and C), seen on 6-month postoperative scan. This patient currently has neither endoleak nor renal compromise. Journal of Vascular Surgery 2012 55, 935-946DOI: (10.1016/j.jvs.2011.11.041) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 6 A, A three-dimensional reconstruction and a (B) postoperative scan at 3 months show an occluded left renal snorkel (arrow) found incidentally without renal compromise. Note the left renal parenchymal loss due to infarct in (A). Journal of Vascular Surgery 2012 55, 935-946DOI: (10.1016/j.jvs.2011.11.041) Copyright © 2012 Society for Vascular Surgery Terms and Conditions