Kilt Technique as an Angle Modification Method for Endovascular Repair of Abdominal Aortic Aneurysm with Severe Neck Angle

Abstract

Purpose: Kilt technique can be useful for overcoming the severe angle in endovascular abdominal aortic repair. Thus, we investigate the utility of the Kilt technique as an angle modification method. Methods: This study included 16 patients with abdominal aortic aneurysm having severe neck angle (over 60°). Of these, eight were treated using Kilt technique, whereas the remaining eight were by the conventional endovascular method. We investigated the pre-and post-procedural differences in neck angle between the two groups using aortic computed tomography (CT) angiography. Results: Mean pre-procedural neck angles in the conventional group and the Kilt group were 70° ± 13° and 93° ± 14° (p = 0.007) and supra-renal neck angles were 54° ± 16° and 89° ± 26°, respectively (p = 0.016). However, the angle differences disappeared between the two groups after the procedure. Consequently, the Kilt group showed greater angle change than the conventional group (p value for ∆ supra-renal angle and ∆ neck angle were 0.015 and 0.021, respectively). There was no type 1 endoleak during 16 ± 16 months of CT follow-up. Conclusion: Kilt technique may be an effective tool for modifying the neck angle without leaving increased risk of type 1 endoleak in this subset of patients.

Endovascular management of aortic aneurysm with severe neck angulation and/or iliac artery tortuosity using multiple stiff wire technique: a case series

“…15 The Kilt technique appeared to significantly straighten neck angle without leaving additional death or re-intervention during 22 AE 15 months follow up and no newly developed endoleaks during 15.9 AE 16.4 months follow up. 16 Although those techniques showed a good result in overcoming the angulation of the aortic neck, they add additional complexity to the procedure, specialized devices, need special training for the operator, and also greater cost of the procedure. Several proposed simple novel techniques such as directional tip control technique, push-up technique, and using a large bore sheath to untwist tortuous iliac arteries seem promising but need further investigation.…”

Successful Percutaneous Endovascular Repair in a Very Large, Symptomatic, Non-ruptured Abdominal Aortic Aneurysm with Severe Neck Angulation

“…Aneurysm features which comprise a hostile neck include, along with their associated complications, a diameter > 30 mm (migration), neck length < 15 mm (type 1 endoleak), mural thrombus > 90 degrees (type 1 endoleak), mural calcification > 90 degrees (migration), and neck angulation > 60 degrees (migration and type 1 endoleak) - the latter of which is the most important determinant for failure of the endovascular repair [3-5]. Failure of endovascular repair is defined as an inability to completely exclude the AAA from the systemic circulation secondary to an inadequate seal between the stent graft and the native aorta wall [13].…”

Đặc Điểm Hình Thái, Kích Thước Và Phân Nhánh Của Động Mạch Chủ Bụng Trên Cắt Lớp Vi Tính Đa Dãy Ở Người Trưởng Thành

“…Cổ túi phình < 15 mm hoặc gập góc > 60 0 là những lý do thường gặp gây khó khăn trong can thiệp nội mạch. [4] Hình 6. Góc cổ túi phình ĐMC bụng dưới thận (Renal neck angle -RNA)…”

“…Nguồn: "Kim T H. và cộng sự", (2017) [4] Tác giả Kornafel và O'Flynn báo cáo số lượng phân nhánh của ĐM thận dao động từ 2 đến 4 nhánh và ĐM thận (P) thường cao hơn (T) trên 50% các TH. [5]…”