Technical tips for successful outcomes using adjunctive procedures during endovascular aortic aneurysm repair

Area of Science:

• Vascular Surgery
• Endovascular Techniques
• Aortic Aneurysm Repair

Background:

• Securing proximal and distal seals remains a significant challenge in endovascular aneurysm repair (EVAR).
• Unsuitable landing zones for endografts complicate achieving adequate graft-to-aortic wall opposition.
• Lack of seal can lead to endoleaks and repair failure.

Purpose of the Study:

• To present two intraoperative techniques to overcome challenges in achieving proximal and distal seal during EVAR.
• To describe the application of Palmaz stents for proximal seal.
• To explain the hypogastric snorkel technique for distal seal with internal iliac artery (IIA) flow preservation.

Main Methods:

• Discussion of Palmaz stent deployment for proximal seal in challenging EVAR cases.
• Description of the hypogastric snorkel technique, including IIA cannulation and stent-graft placement.
• Focus on intraoperative strategies to ensure graft-to-wall apposition.

Main Results:

• Palmaz stents can facilitate proximal seal in cases with inadequate landing zones.
• The hypogastric snorkel technique allows for distal seal while preserving flow to the internal iliac artery.
• Both techniques aim to improve the durability and success of EVAR in complex anatomies.

Conclusions:

• Palmaz stents and hypogastric snorkels are valuable adjuncts for achieving seal in EVAR.
• These techniques address critical challenges posed by unsuitable landing zones.
• Successful implementation can enhance EVAR outcomes and patient safety.