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Early experience with the snorkel technique for juxtarenal aneurysms

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Presentation on theme: "Early experience with the snorkel technique for juxtarenal aneurysms"— Presentation transcript:

1 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 (April 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 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  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 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  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 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  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

5 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  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

6 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  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

7 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  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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