Endovascular aneurysm repair using fenestrated endoprostheses made to order from the manufacturer: Case report

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Abstract

This article presents two clinical cases of endovascular aneurysm repair using fenestrated endografts manufactured by the manufacturer in patients with juxta and pararenal aortic aneurysm. The variants of endovascular approaches to the treatment of pathology were analyzed. Clinical examples show the specifics of the choice and justification for the use of endovascular treatment. The conclusion is made about the effectiveness of the method.

About the authors

Sergey A. Abugov

Petrovsky Russian Research Center of Surgery

Email: editor@omnidoctor.ru
ORCID iD: 0000-0001-7636-4044

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Gordey S. Vlasko

Petrovsky Russian Research Center of Surgery

Author for correspondence.
Email: Vlasko13@yandex.ru
ORCID iD: 0000-0001-8521-7126

Graduate Student

Russian Federation, Moscow

Roman S. Polyakov

Petrovsky Russian Research Center of Surgery; Russian Medical Academy of Continuous Professional Education

Email: editor@omnidoctor.ru
ORCID iD: 0000-0002-9323-4003

D. Sci. (Med.), Petrovsky Russian Research Center of Surgery

Russian Federation, Moscow; Moscow

Mikhail V. Puretskiy

Petrovsky Russian Research Center of Surgery; Russian Medical Academy of Continuous Professional Education

Email: editor@omnidoctor.ru
ORCID iD: 0000-0003-4988-4102

D. Sci. (Med.)

Russian Federation, Moscow; Moscow

Gayk V. Mardanyan

Petrovsky Russian Research Center of Surgery

Email: editor@omnidoctor.ru
ORCID iD: 0000-0002-7442-520X

Cand. Sci. (Med.)

Russian Federation, Moscow

Aleksandra A. Pirkova

Petrovsky Russian Research Center of Surgery

Email: editor@omnidoctor.ru
ORCID iD: 0000-0002-5101-1004

Cand. Sci. (Med.)

Russian Federation, Moscow

Dzhul’etta A. Karamyan

Petrovsky Russian Research Center of Surgery

Email: editor@omnidoctor.ru
ORCID iD: 0000-0001-7803-4698

Graduate Student

Russian Federation, Moscow

Shota G. Chargaziya

Petrovsky Russian Research Center of Surgery

Email: editor@omnidoctor.ru
ORCID iD: 0000-0002-8598-2933

Graduate Student

Russian Federation, Moscow

Kiazim A. Kur-ipa

Petrovsky Russian Research Center of Surgery

Email: editor@omnidoctor.ru
ORCID iD: 0000-0002-2395-5999

Graduate Student

Russian Federation, Moscow

References

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  2. Schanzer A, Greenberg RK, Hevelone N, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation. 2011;123(24):2848-55. doi: 10.1161/CIRCULATIONAHA.110.014902
  3. Park JH, Chung JW, Choo IW, et al. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: Preliminary experience. J Vasc Interv Radiol. 1996;7(6):819-23. doi: 10.1016/S1051-0443(96)70854-0
  4. Faruqi RM, Chuter TAM, Reilly LM, et al. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft. J Endovasc Surg. 1999;6(4):354-8. doi: 10.1177/152660289900600411
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  6. D’Oria M, Galeazzi E, Veraldi GF, et al. Impact of proximal neck anatomy on short-term and mid-term outcomes after treatment of abdominal aortic aneurysms with new-generation low-profile endografts. Results from the multicentric “ITAlian North-East Registry of ENDOvascular Aortic Repair With the BOltOn Treo Endograft (ITA-ENDOBOOT)”. Ann Vasc Surg. 2022;80:37-49. doi: 10.1016/j.avsg.2021.08.059
  7. Karathanos C, Spanos K, Kouvelos G, et al. Hostility of proximal aortic neck anatomy in relation to abdominal aortic aneurysm size and its impact on the outcome of endovascular repair with the new generation endografts. J Cardiovasc Surg (Torino). 2020;61(1):60-6. doi: 10.23736/S0021-9509.18.10001-2
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  9. Mirza AK, Kärkkäinen JM, Tenorio ER, et al. Emergency endovascular repair of symptomatic post-dissection thoraco-abdominal aneurysm using a physician modified fenestrated endograft during the waiting period for a manufactured endograft. EJVES Vasc Forum. 2020;49:11-5. doi: 10.1016/j.ejvsvf.2020.08.003
  10. Georgiadis GS, van Herwaarden JA, Antoniou GA, et al. Systematic Review of Off-the-Shelf or Physician-Modified Fenestrated and Branched Endografts. Journal of Endovascular Therapy. 2016;23(1):98-109. doi: 10.1177/1526602815611887
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  15. Newton DH, Etkin Y, Foley PJ 3rd, et al. Maximizing proximal seal zone in fenestrated endografting: Evolution in the approach to graft configuration. J Vasc Surg. 2020;72(6):1891-6. doi: 10.1016/j.jvs.2020.03.049

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2. Рис. 1. Клинический пример 1. ЭВП заранее подготовленным ФЭГ: А – МСКТ-АГ брюшной аорты, прямая проекция; В – началь- ный этап имплантации: открыто 1-е звено и частично раскрыто 2-е, совмещены метки ЭВПр с устьями артерий; С – имплантация ЭГ, катетеризированы устья ПА, через интродьюсеры 7 Fr заве- дены стент-графты в ПА; D, E, F, G – последовательная импланта- ция стент-графтов в ПА; H – контрольная аортография: позиция ЭГ удовлетворительная, аневризма выключена из кровотока; I, J – контрольная МСКТ-АГ в госпитальный период: отмечается полное выключение аневризмы из кровотока.

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3. Рис. 2. Клинический пример 2. ЭВП заранее подготовленным ФЭГ: А – МСКТ-АГ брюшной аорты, прямая проекция; В – началь- ный этап имплантации: открыто 1-е звено и частично раскрыто 2-е, совмещены метки ЭВПр с устьями артерий; С – имплантация ЭГ без раскрытия проксимальной короны, катетеризированы устья ПА, заведены интродьюсеры 7 Fr; D, E – последовательная имплантация стент-графтов в ПА; F – баллонная дилатация ЭВПр; G – контрольная аортография: позиция ЭГ удовлетворительная, аневризма выключена из кровотока; H, I – контрольная МСКТ-АГ в госпитальный период: отмечается полное выключение анев- ризмы из кровотока

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4. Рис. 3. Индивидуальный протокол, прилагаемый к изготов- ленному на заказ ФЭГ.

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5. Рис. 4. Конфигурации ЭВПр Zenith (по D. Newton и соавт. [15]): А – с вырезкой; В – с полноценной фенестрацией.

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