ABSTRACT
PURPOSE: To describe the use of in situ fenestration to facilitate management of a disconnected iliac stent-graft limb that could not be repaired by conventional endovascular techniques. TECHNIQUE: An 85-year-old man who had a Zenith endovascular graft deployed 3 years earlier for a 10-cm infrarenal abdominal aortic aneurysm presented with separation of the right iliac stent-graft limb from the main body, resulting in type III endoleak and sac enlargement. The disconnected limb occluded the ostium of the main stent-graft body, blocking all conventional endovascular techniques to traverse the graft limb-main body intersection. To overcome the problem, the cephalad portion of the proximal disconnected limb overlying the main body gate was successfully fenestrated with an endoscopic FNA needle and continuity restored with a Viabahn stent-graft across the balloon-modeled fenestration. CONCLUSION: In situ fenestration of endovascular stent-grafts may be a useful adjunct in performing rescues of late complications in patients not suitable for open repair.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endoleak/surgery , Endoscopy , Endovascular Procedures/instrumentation , Graft Occlusion, Vascular/surgery , Iliac Artery/surgery , Prosthesis Failure , Stents , Aged, 80 and over , Angiography, Digital Subtraction , Aortic Aneurysm, Abdominal/diagnostic imaging , Blood Vessel Prosthesis Implantation/adverse effects , Endoleak/diagnostic imaging , Endoleak/etiology , Endoscopy/instrumentation , Endovascular Procedures/adverse effects , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Humans , Iliac Artery/diagnostic imaging , Male , Needles , Prosthesis Design , Reoperation , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
While prior reports have demonstrated intravascular ultrasound (IVUS)-guided inferior vena cava filter (IVCF) deployment to be feasible, larger reviews using the latest generation of filters in the nontrauma setting are absent. We review our experience with the deployment of 104 IVCFs using IVUS, whereby we transition from a combined use of IVUS with traditional road mapping techniques (venography and/or renal vein cannulation) to the sole use of the IVUS as the road mapping tool for IVCF insertion. The use of IVUS for IVCF deployment minimizes radiation exposure to patients and staff, minimizes patient contrast exposure, and minimizes dependency on auxiliary staff for fluoroscopy. Intravascular ultrasound IVCF deployments can be performed without increasing morbidity and mortality, case duration, or overall costs when compared to standard deployments. The learning curve for transitioning into the use of the IVUS as the primary road mapping tool for IVCF deployments is approximately 20 cases.
