Treatment of aortic arch aneurysms with a modular transfemoral multibranched stent graft: initial experience.

OBJECTIVES: To present initial experience with a new modular transfemoral multibranched stent graft for treating aortic arch aneurysms. METHODS: Six patients, considered high risk for open surgery, were treated with custom made branched stent grafts. All patients had a staged left carotid subclavian bypass before the endovascular procedure. Each branched graft had a 12 mm side branch for the innominate artery and an 8 mm side branch for the left common carotid artery. RESULTS: Four patients out of six had uneventful placement of the prostheses, with successful exclusion of their aneurysms. One patient developed a type I endoleak that was managed successfully with coiling and gluing of the aneurysm sac. In one patient, cannulation of the innominate branch was unsuccessful and an extra-anatomic bypass was necessary to perfuse the right carotid and vertebral arteries. This patient developed a stroke, while one more suffered a right cerebellar infarct. CONCLUSION: We have demonstrated the technical feasibility of a modular transfemoral branched stent graft for treatment of aortic arch aneurysms. The method is relatively safe based on initial experience. More cases and long-term follow up are necessary to evaluate the efficacy and safety of this new device.

Endovascular repair of abdominal aortic aneurysm with coexisting renal allograft: case report and literature review.

The coexistence of an abdominal aortic aneurysm (AAA) and a pelvic renal allograft is a unique clinical situation. Because of the increased susceptibility of the transplant kidney to ischemic injury, various approaches have been developed to minimize allograft ischemia during open aneurysm repair. Endovascular techniques have the potential advantage in this situation of greatly diminishing renal ischemia time. To our knowledge, this approach has not been reported in this situation. We report a case of a 61-year-old male with a 7.0-cm AAA and a functioning right pelvic transplant kidney. There was an adequate aneurysm neck below the level of the superior mesenteric artery with occluded renal arteries. Successful endovascular repair of the aneurysm was achieved using a bifurcated graft and bilateral iliac extensions. Perfusion to the renal allograft was maintained throughout the procedure except for short periods when the graft was expanded with a balloon. Short-term follow-up reveals successful aneurysm exclusion and no deterioration in renal function. This exciting new approach to this challenging clinical problem is reviewed along with other methods of minimizing renal allograft ischemia.