Inner tubing endograft: a new technique for bifurcation preservation

Abstract

Treating narrow arteries and their bifurcations is a major challenge to the endovascular surgeon. We describe a new endovascular technique that was used to treat a narrow aorta and that may also be used to preserve other bifurcations. Using three straight stents may enable the endovascular surgeon to treat bifurcation while maintaining flow to both distal arteries.

Inner tubing technique used for the treatment of anastomotic aneurism

“…In the treatment of patients with increasingly severe conditions, the improvement of prostheses and refinement of the endovascular techniques are accompanied by encouraging results 1 . Several techniques are available for the treatment of aneurysms 2 , 3 , 4 , but in the case reported herein the inner tubing technique was chosen, which was developed for bifurcation lesions where conventional vascular endoprosthesis are unavailable or the anatomy does not fit the available endoprosthesis 5 . The aortomonnoiliac endovascular grafting technique would be, indeed, an adequate procedure for this case, but it would involve a higher surgical risk and the requirement of an aortic endoprosthesis that was unavailable in our service.…”

“…The aortomonnoiliac endovascular grafting technique would be, indeed, an adequate procedure for this case, but it would involve a higher surgical risk and the requirement of an aortic endoprosthesis that was unavailable in our service. Thus, a straight stent was set in place to create a “proximal neck,” followed by the insertion (within the first stent) of two other parallel stents using the “kissing” maneuver plotting up a branch in each artery bifurcation 5 . In our patient, since the previous inserted prosthesis was in the aortic position, it was only necessary to complete the technique by deploying the iliac extensions bilaterally.…”

“…This technique, besides the preservation of vascular bifurcations, 5 presents the following advantages: (i) the use of easily available, off-the-shelf, covered stents without the need for individualized customization; (ii) a full approach by inguinotomy without the need for a laparotomy in a previously operated abdomen; (iii) the preservation of two iliac arteries without the necessity of the performance of an aortic-monoiliac graft associated with a femorofemoral crossover bypass; (iv) the preservation of the hypogastric arteries; (v) reduced hospitalization time; and (vi) reduced time of anesthesia. On the other hand, the main early- and mid-term complication of any endovascular procedure/treatment is represented by the proximal and distal endoleaks.…”

“…The inner tubing technique seems to be a viable therapeutic option accompanied by a promising outcome, besides being a minimally invasive method for the correction of complex lesions in high-risk patients with a hostile abdomen. 5 Larger studies and longer follow-up are still needed to assure promising results in other cases.…”

Chimney Endograft for Pararenal Chronic Contained Rupture of the Abdominal Aortic Aneurysm Using the Lift Technique as a Bailout Strategy A Case Report

“…Endovascular techniques are less invasive methods of treating infrarenal abdominal aortic aneurysms (AAAs) especially for patients with severe comorbidities [5]. Endovascular aortic repair with parallel stents in the visceral arteries [6], the chimney technique (ChEVAR), is an important treatment option in high-risk patients with o juxtarenal (JRAAA), pararenal (PRAAA), and Crawford type IV thoraco-abdominal (TAAA) aneurysms [7,8]. However, this method requires selective catheterization…”