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Endovascular Neck Stabilization Before EVAR for Infrarenal Aortic Aneurysm in Chronic Aortic Dissection

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  • Arterial Interventions
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Abstract

Background

Endovascular treatment of infrarenal abdominal aortic aneurysm (AAA) with proximal chronic aortic dissection is challenging as a false and true lumen at the level of the infra-renal neck does not allow a sufficient landing zone. We describe staged endovascular neck stabilization prior to standard endovascular aortic repair (EVAR) for AAA with chronic aortic dissection.

Technique

To create a stable proximal neck (PN) by closing entry tears, thereby resulting in total false lumen thrombosis (FLT) prior to standard EVAR. Case 1 false lumen fenestrations were present at the descending aorta, the right renal artery orifice and PN. After closing the entry tear by thoracic EVAR, an aortic cuff was placed in the true lumen of the PN and renal stenting for the right renal artery was performed. After 2 months, total FLT was achieved, and EVAR was performed. Case 2 false lumen fenestrations were present at the descending, super celiac aorta and PN. After closing the entry by TEVAR, aortic cuffs were placed at infrarenal aorta to close residual entries. After 1 month of achieving total FLT, EVAR was performed. Both cases had no type 1 endoleak during follow-up.

Conclusion

The endovascular neck stabilization is a useful treatment option that facilitates standard EVAR for AAA in chronic aortic dissection.

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Acknowledgements

The idea was created by Dr. Hiroshi Nishimaki.

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Authors and Affiliations

  1. Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Yukihisa Ogawa, Tomotaka Iraha, Kiyoshi Chiba, Akiyuki Kotoku & Hidefumi Mimura

  2. Department of Cardiovascular Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Hiroshi Nishimaki & Takeshi Miyairi

  3. Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan

    Takaaki Maruhashi

  4. Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA, 94305, USA

    Nathan K. Itoga

  5. Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA, 94305, USA

    Yukihisa Ogawa & Amelia Claire Watkins

Authors
  1. Yukihisa Ogawa
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  2. Hiroshi Nishimaki
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  3. Tomotaka Iraha
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  4. Nathan K. Itoga
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  5. Kiyoshi Chiba
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  6. Akiyuki Kotoku
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  7. Takaaki Maruhashi
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  8. Hidefumi Mimura
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  9. Amelia Claire Watkins
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  10. Takeshi Miyairi
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Corresponding author

Correspondence to Yukihisa Ogawa.

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Ogawa, Y., Nishimaki, H., Iraha, T. et al. Endovascular Neck Stabilization Before EVAR for Infrarenal Aortic Aneurysm in Chronic Aortic Dissection. Cardiovasc Intervent Radiol 42, 1483–1487 (2019). https://doi.org/10.1007/s00270-019-02277-8

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  • DOI: https://doi.org/10.1007/s00270-019-02277-8

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