Treatment of a type Ia endoleak following EVAR using a custom-made inner branch device.

Abstract

Objectives We represent two cases of late proximal type I endoleak following EVAR with aneurysm expansion that were treated with a custom-made graft with inner branches. Methods Two patients of 87 and 82 years old were operated by EVAR 6 and 8 years ago for abdominal aortic aneurysm. Both had proximal type I endoleak with aneurysm sac expansion. Open surgery had a high risk, and a proximal aortic extension with a simple aortic cuff was not possible neither because previous EVAR grafts were already at the level of the renal arteries. A custom-made endograft with inner branches was planned as a fenestrated graft was not technically possible. Results We successfully treated both patients using a custom-made graft with four inner branches from Jotec (Cryolife, Kennesaw, GA). Three months’ follow-up CT scan did not show any endoleaks. All target vessels were patent with good conformability of the bridging stents. Conclusion The treatment of proximal type I endoleak using inner branches’ endografts is feasible. This novel technology might broaden the indications for complex aortic repair in a group of patients where fenestrated endografts are not possible.

Abdominal aortic aneurysm surgery with a modern method - is there anything to fear?

“…Najczęściej nie są one bezpośrednim zagrożeniem dla zdrowia i życia pacjenta jednak wymagają dodatkowej interwencji medycznej. Najczęstszym powikłaniem jest przeciek około protezowy [4,11,12,13,14,15,16,17,18]. Pomimo rozwiniętych metod naprawczych, najlepszym rozwiązaniem dla dobra pacjenta będzie udoskonalenie techniki stentgraftu celem wykluczenia jak największej liczby powikłań wczesnych jak i późnych aby nie narażać chorych na ponowne zabiegi które mogą wpływać na ich dalsze rokowanie.…”