骶尾部内脏主动脉瘤的支架辅助线圈栓塞术:病例报告和文献综述。

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2024-12-01 Epub Date: 2023-03-29 DOI:10.1177/15266028231162259
Lorenzo Gibello, Gianfranco Varetto, Vittorio Pasta, Matteo Ripepi, Andrea Discalzi, Fabio Verzini
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引用次数: 0

摘要

目的:我们介绍了对一名 78 岁女性的巨大(65 毫米)囊状内脏主动脉瘤进行非常规血管内治疗的结果。患者因合并症被认为不适合进行开放手术。由于主动脉直径较小,腹腔干起源处严重狭窄,肠系膜上动脉起源异常,因此也排除了栅栏或分支内移植术:在对肠系膜上动脉进行初步选择性血管造影,显示其与腹腔干分支的吻合网络有效后,在内脏主动脉中植入了主动脉自膨胀裸支架(Jotec E-XL)。采用线圈栓塞技术对动脉瘤囊进行栓塞(Penumbra 可拆卸红宝石线圈)。最后,在紧靠左肾动脉源头的上方部署了主动脉袖带内移植物(戈尔公司),以覆盖囊状动脉瘤的宽颈部并改善瘤囊排除情况。住院期间一切顺利,12 个月后的计算机断层扫描(CT)显示动脉瘤缩小至 62 毫米,无内漏图像。文献综述显示,该技术已成功应用于处理高危患者手术后和创伤后囊主动脉瘤的类似病例;然而,长期效果仍不得而知:结论:当开腹手术或传统的血管内治疗不可行时,可以考虑采用螺旋狱技术治疗囊主动脉瘤。技术成功和中期疗效良好,但建议严格随访:本研究旨在分享对一名不适合开放手术和传统血管内手术的内脏主动脉瘤患者进行的非常规血管内治疗。据我们所知,这是文献中发表的首例病例之一,为此,我们制作了一个分步骤的视频来描述手术过程。随后,我们对文献进行了回顾,分析了这种技术的中期效果。尽管这种治疗方法并不推荐用于常规病例,但对血管内设备和技术的了解可能有助于处理或简化复杂的主动脉疾病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Stent-Assisted Coil Embolization of a Saccular Visceral Aortic Aneurysm: Case Report and Review of the Literature.

Purpose: We present the results of unconventional endovascular treatment of a voluminous (65 mm) saccular visceral aortic aneurysm in a 78-year-old woman. Patient was deemed unfit for open surgery due to comorbidities. Fenestrated or branched endografting was also excluded due to the small diameter of the aorta, the severe stenosis at the origin of celiac trunk, and the anomalous origin of superior mesenteric artery arising infrarenally.

Case report: After a preliminary selective angiography of the superior mesenteric artery showing valid anastomotic network with celiac trunk branches, an aortic self-expandable bare stent (Jotec E-XL) was deployed in the visceral aorta. Aneurysm sac embolization (Penumbra detachable Ruby Coils) in a coil-jailing technique was performed. Finally, an aortic cuff endograft (Gore) was deployed immediately above the origin of the left renal artery to cover the wide neck of the saccular aneurysm and improve sac exclusion. Hospital stay was uneventful, computed tomography (CT) at 12-month demonstrated aneurysm shrinkage to 62 mm without images of endoleak. Literature review showed how this technique has successfully been applied to manage similar cases of postsurgical and posttraumatic saccular aortic aneurysms in high-risk patients; however, long-term results are still unknown.

Conclusion: Coil-jail technique for the treatment of saccular aortic aneurysms can be considered an alternative when open surgery or conventional endovascular treatment is not feasible. Technical success and mid-term outcomes are promising but strict follow-up is recommended.

Clinical impact: This study aims to share the unconventional endovascular treatment of a visceral aortic aneurysm in a patient unfit both for open and traditional endovascular surgery. To the best of our knowledge this is one of the first cases published in Literature, for this reason, a step-by-step video has been created to describe the procedure. Literature review was then performed to analyze midterm results of this technique. Despite being a treatment that is not recommended for conventional cases, the knowledge of endovascular devices and techniques may help to manage or simplify complex aortic diseases.

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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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