Novel technique for endovascular salvage of a folded aortic endograft

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Presentation transcript:

Novel technique for endovascular salvage of a folded aortic endograft Joseph J. Ricotta, MD, Rafael D. Malgor, MD Journal of Vascular Surgery Volume 52, Issue 3, Pages 785-789 (September 2010) DOI: 10.1016/j.jvs.2010.03.049 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Preoperative CTA showing an AneuRx aortic endograft that had migrated caudally into the aneurysm sac and was folded over on itself creating a large type I endoleak. Note the stent graft within the aneurysm sac and the distance between the proximal edge of the stent graft and the aortic neck (right side CTA image). Journal of Vascular Surgery 2010 52, 785-789DOI: (10.1016/j.jvs.2010.03.049) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Intraoperatively angiogram showing a bent endograft that migrated within the aneurysm sac. Note distance between endograft and left renal artery and large type I endoleak, demonstrated by arrows inside aneurysm sac in B. Journal of Vascular Surgery 2010 52, 785-789DOI: (10.1016/j.jvs.2010.03.049) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 A and B, Two 14- × 4-cm balloons were advanced up into each limb of the endograft from the femoral arteries and inflated causing the main body of stent graft to partially straighten out and unfold its proximal portion. C and D, Illustration of the aforementioned steps. Journal of Vascular Surgery 2010 52, 785-789DOI: (10.1016/j.jvs.2010.03.049) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 A, Goose neck snare advanced down into aorta through the left brachial artery. B and C, Stiff angled glide wires snared from above and pulled cephalad completely straightening out the endografts. Journal of Vascular Surgery 2010 52, 785-789DOI: (10.1016/j.jvs.2010.03.049) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 A, An aortic cuff extension (in this case a 37-mm × 10-cm TAG thoracic stent graft) was deployed just below the renal arteries and deployed to the flow divider of the rescued AneuRx endograft to achieve proximal seal and resolve the type I endoleak. B, Completion angiogram demonstrating a successful proximal seal with no residual endoleak and patent right and left renal arteries. Journal of Vascular Surgery 2010 52, 785-789DOI: (10.1016/j.jvs.2010.03.049) Copyright © 2010 Society for Vascular Surgery Terms and Conditions