Should patients with challenging anatomy be offered endovascular aneurysm repair? Roy K Greenberg, MD, Daniel Clair, MD, Sunita Srivastava, MD, Guru Bhandari,

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Presentation transcript:

Should patients with challenging anatomy be offered endovascular aneurysm repair? Roy K Greenberg, MD, Daniel Clair, MD, Sunita Srivastava, MD, Guru Bhandari, MS, Adrian Turc, MD, Jennifer Hampton, RN, Matt Popa, BS, Richard Green, MD, Kenneth Ouriel, MD Journal of Vascular Surgery Volume 38, Issue 5, Pages 990-996 (November 2003) DOI: 10.1016/S0741-5214(03)00896-6

Fig 1 Self-expanding stents can be used to raise the effective renal artery origin in conjunction with an endovascular graft. A, Brachial access (arrow) ensures access into a renal artery during and after deployment of the endovascular graft. B, Deployed self-expanding stent protects the renal artery ostium (arrow). Graft material marker immediately below the stent is located approximately 1 to 2 mm below the fabric edge. Stent affords the necessary protection to place the graft material this high, enabling maximal coverage of the available proximal neck and preserving the renal artery. Opposite the self-expanding stent is a balloon-expandable stent that was placed before the procedure and subsequently dilated to ensure adequate expansion at the renal ostium after inflation of an aortic balloon. Journal of Vascular Surgery 2003 38, 990-996DOI: (10.1016/S0741-5214(03)00896-6)

Fig 2 Relative distribution of maximal infrarenal neck angulation between the two groups is depicted in graphic form. Black bars, Low risk; gray bars, high risk. Journal of Vascular Surgery 2003 38, 990-996DOI: (10.1016/S0741-5214(03)00896-6)

Fig 3 Relative distribution of proximal neck length between the two groups is depicted in graphic form. Neck length in patients at high anatomic risk was significantly shorter than in patients at low anatomic risk (P < .01). Journal of Vascular Surgery 2003 38, 990-996DOI: (10.1016/S0741-5214(03)00896-6)

Fig 4 Absolute aneurysm diameter change over long-term follow-up. Diamonds, Low risk; squares, high risk. Journal of Vascular Surgery 2003 38, 990-996DOI: (10.1016/S0741-5214(03)00896-6)

Fig 5 Relative change in aneurysm size in patients without type II endoleak (top) and with type II endoleak (bottom). Note that slope equation (function) associated with each line can be used to predict how the aneurysm sac will perform over time. Solid lines, Low risk; dashed lines, high risk. Journal of Vascular Surgery 2003 38, 990-996DOI: (10.1016/S0741-5214(03)00896-6)