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An In Vitro Approach to Photodynamic Therapy
Published on: August 17, 2018
[In Process Citation]
László Entz1, Balázs Nemes, Zoltán Szeberin
1Érsebészeti Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar 1122 Budapest, Városmajor u. 68.
Insights
Fenestrated stent grafts offer a minimally invasive solution for complex juxtarenal abdominal aortic aneurysms. While short-term outcomes are promising, long-term results require further investigation.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Treatment
Context:
- Juxtarenal abdominal aortic aneurysms (JAAs) pose significant surgical challenges due to their proximity to visceral arteries.
- Conventional open repair is associated with high morbidity and mortality, especially in patients with multiple comorbidities.
- Advancements in endovascular techniques, including fenestrated stent grafts, provide alternative treatment options.
Purpose:
- To report the initial clinical experience with custom-made fenestrated stent grafts for treating complex juxtarenal abdominal aortic aneurysms.
- To evaluate the technical success, early complications, and mid-term outcomes of this endovascular approach.
- To highlight the feasibility of treating JAAs with visceral involvement using fenestrated endovascular repair.
Summary:
- Two patients with complex juxtarenal abdominal aortic aneurysms underwent successful endovascular repair using custom-made fenestrated stent grafts.
- The first patient experienced a temporary left renal stent occlusion requiring reintervention, while the second patient had patent fenestrations at one month.
- The study demonstrates the potential of fenestrated endovascular repair for JAAs, with short- and mid-term results comparing favorably to open surgery.
Impact:
- Fenestrated endovascular repair represents a significant advancement in treating complex aortic aneurysms, potentially reducing surgical risks.
- This technology enables complete endovascular solutions for juxtarenal aneurysms involving visceral arteries.
- Further long-term studies are needed to fully ascertain the durability and benefits of fenestrated endograft technology compared to traditional surgical methods.
Case Report:
The first case was a 77-year-old man with 5.6 cm juxtarenal abdominal aortic aneurysm who presented with multiple comorbidities. The patient had a single left kidney. A custom-made, single fenestrated stent graft was implanted successfully. The one-month follow-up showed a patent left renal fenestration without evidence of any endoleaks. Four months after the operation the patient was admitted with acute uremia. Imaging studies revealed an occluded left renal stent, which was successfully reopened. The second case was a 71-year-old man with 8.0 cm juxtarenal aneurysm. He presented with severe coronary artery disease among other multiple comorbidities in his medical history. He was successfully treated with a 3-vessel custom-made fenestrated stent graft to the renal and the superior mesenteric arteries. The one-month CT imaging revealed patent fenestrations without endoleaks.
Discussion:
With the development of fenestrated endograft technology, complex aneurysms with visceral artery involvement can be treated with complete endovascular approaches. The first fenestrated endovascular case in Hungary was treated in the Heart and Vascular Center of Semmelweis University, Budapest. The short and middle-term results are offering improved clinical results when compared with conventional surgery, but the long-term outcomes are difficult to ascertain from the current published series.
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