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Fenestrate what you can't snorkel?
Mohamed A Zayed1, Mohammed Chowdhury, Kevin Casey
1Department of Surgery, Stanford University Medical Center, Stanford, CA 94305, USA.
Annals of Vascular Surgery
|June 6, 2012
Summary
Fenestrated endovascular repair (f-EVAR) successfully treated a juxtarenal abdominal aortic aneurysm (AAA) when snorkel EVAR (sn-EVAR) was not feasible due to patient anatomy. This case highlights f-EVAR as a viable option for complex AAA repair.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Abdominal Aortic Aneurysm
Background:
- Challenging proximal necks limit standard EVAR for juxtarenal AAAs.
- Snorkel EVAR (sn-EVAR) and fenestrated EVAR (f-EVAR) are advanced options for high-risk AAAs.
- Limited long-term data exists for sn-EVAR and f-EVAR in the US.
Observation:
- A 72-year-old patient with a juxtarenal AAA and comorbidities presented for repair.
- Initial sn-EVAR attempt failed due to renal artery anatomy (stenosis and cephalad angulation).
- A subsequent f-EVAR approach was successfully employed.
Findings:
- f-EVAR successfully repaired the juxtarenal AAA, preserving renal artery blood flow.
- Two-year follow-up showed a stable repair, shrinking aneurysm sac, and preserved renal function.
- Cephalad renal angulation precluded sn-EVAR, demonstrating its anatomical limitations.
Implications:
- f-EVAR is a valuable alternative when sn-EVAR is anatomically contraindicated.
- Successful f-EVAR suggests its utility in complex juxtarenal AAA cases.
- Further delineation of anatomic indications for advanced EVAR techniques is necessary.
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