Branched Endovascular Aortic Repair After a Migrated EVAR Bypassing a Severely Kinked Previous Endograft

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dc.contributor.authorTorrealba, Jose, I
dc.contributor.authorKolbel, Tilo
dc.contributor.authorRohlffs, Fiona
dc.contributor.authorSpanos, Konstantinos
dc.contributor.authorPanuccio, Giuseppe
dc.date.accessioned2025-01-20T17:12:20Z
dc.date.available2025-01-20T17:12:20Z
dc.date.issued2024
dc.description.abstractPurpose: To describe a novel technique to repair a juxtarenal abdominal aortic aneurysm (JAAA) after failed endovascular aortic repair (EVAR) with severely kinked anatomy. Technique: We present a patient who underwent an EVAR with a Medtronic Talent device 15 years ago and a proximal cuff extension 3 years earlier for an abdominal aortic aneurysm. Computed tomography (CT) done for a known gastritis showed a 12 cm JAAA, with a migrated endograft and a type Ia endoleak (EL). Endovascular repair was performed, accessing and navigating the aneurysmal sac outside the previous graft. The type I EL was reached and the suprarenal aorta catheterized. A 4-vessel inner-branched EVAR device was deployed in the distal thoracic aorta and their target vessels bridged through femoral access. A distal bifurcated component was deployed and both iliac limbs were extended to the native distal iliac arteries. Completion angiogram as well as early and 12-month CT showed a fully patent straight course branched EVAR with no ELs. Conclusion: Complex aortic reinterventions in the presence of previous EVAR can be performed by choosing a straighter course along and parallel to the previous endograft. Several technical aspects must be considered to successfully perform this type of reinterventions. Clinical Impact We present a technique of a complex endovascular aortic repair in a failed EVAR with kinked anatomy, navigating through the thrombosed aneurysmal sac, outside the previously placed endograft and thus obtaining a straighter path for a new branched endograft. The novelty lies in a different approach to repair a failed EVAR with a branched graft through an uncommon access on the side of the previous endograft, avoiding repeated displacement or occlusion of the new endograft. We exemplify the feasibility of such a complex procedure and highlight important steps to perform it, whether in the abdominal or even thoracic Aorta.
dc.fuente.origenWOS
dc.identifier.doi10.1177/15266028221134888
dc.identifier.eissn1545-1550
dc.identifier.issn1526-6028
dc.identifier.urihttps://doi.org/10.1177/15266028221134888
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/91245
dc.identifier.wosidWOS:000884865800001
dc.issue.numero4
dc.language.isoen
dc.pagina.final540
dc.pagina.inicio533
dc.revistaJournal of endovascular therapy
dc.rightsacceso restringido
dc.subjectendovascular aneurysm repair
dc.subjectabdominal aortic aneurysm
dc.subjectendovascular procedures
dc.subjectcomplex endovascular repair
dc.subjectprevious aortic surgery
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleBranched Endovascular Aortic Repair After a Migrated EVAR Bypassing a Severely Kinked Previous Endograft
dc.typeartículo
dc.volumen31
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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