Eisaku Ito1, Takao Ohki2, Naoki Toya1, Hikaru Nakagawa1, Ryou Nishide1, Kohei Okazaki1, Tadashi Akiba3. 1. Department of Vascular Surgery, The Jikei University Kashiwa Hospital, Kashiwa city, Chiba prefecture, Japan. 2. Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato City, Tokyo, 105-8471, Japan. takohki@msn.com. 3. Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa city, Chiba prefecture, Japan.
Abstract
BACKGROUND: The snorkel technique for a juxtarenal abdominal aortic aneurysm (JAAA) is an important treatment option for high-risk patients. We report the lift snorkel technique through the trans-femoral access for a type Ia endoleak after fenestrated endovascular aneurysm repair (FEVAR) in a case of difficult trans-brachial access. CASE PRESENTATION: A 76-year-old woman who had JAAA presented with a type Ia endoleak and sac expansion after FEVAR. We planned for proximal additional stentgraft with the bilateral renal artery snorkel technique. However, during the secondary intervention, it was difficult to cannulate to the left renal artery through the trans-brachial access due to interference of the supra-renal stent. Stentgraft was eventually delivered into the left renal artery via the trans-femoral access with a 5 Fr sheath. A plain angioplasty balloon was inserted coaxially through the sheath. The balloon was inflated in the proximal end of the stentgraft and then pushed up to replace the proximal end from down to up. The additional aortic cuff was deployed parallel to the snorkel stentgraft. One year after the additional treatment, computed tomography (CT) revealed aneurysm sac shrinkage. CONCLUSION: The lift snorkel technique is a unique method converting the retrograde approach to antegrade renal artery stenting and would be an effective option for difficult trans-brachial cases for a type Ia endoleak after FEVAR of a JAAA.
BACKGROUND: The snorkel technique for a juxtarenal abdominal aortic aneurysm (JAAA) is an important treatment option for high-risk patients. We report the lift snorkel technique through the trans-femoral access for a type Ia endoleak after fenestrated endovascular aneurysm repair (FEVAR) in a case of difficult trans-brachial access. CASE PRESENTATION: A 76-year-old woman who had JAAA presented with a type Ia endoleak and sac expansion after FEVAR. We planned for proximal additional stentgraft with the bilateral renal artery snorkel technique. However, during the secondary intervention, it was difficult to cannulate to the left renal artery through the trans-brachial access due to interference of the supra-renal stent. Stentgraft was eventually delivered into the left renal artery via the trans-femoral access with a 5 Fr sheath. A plain angioplasty balloon was inserted coaxially through the sheath. The balloon was inflated in the proximal end of the stentgraft and then pushed up to replace the proximal end from down to up. The additional aortic cuff was deployed parallel to the snorkel stentgraft. One year after the additional treatment, computed tomography (CT) revealed aneurysm sac shrinkage. CONCLUSION: The lift snorkel technique is a unique method converting the retrograde approach to antegrade renal artery stenting and would be an effective option for difficult trans-brachial cases for a type Ia endoleak after FEVAR of a JAAA.
Authors: Rakesh P Patel; Athanasios Katsargyris; Eric L G Verhoeven; Donald J Adam; John A Hardman Journal: Cardiovasc Intervent Radiol Date: 2013-05-15 Impact factor: 2.740
Authors: Surabhi Madhwal; Vivek Rajagopal; Deepak L Bhatt; Christopher T Bajzer; Patrick Whitlow; Samir R Kapadia Journal: J Invasive Cardiol Date: 2008-05 Impact factor: 2.022