Abstract
Endovascular treatment of abdominal aortic aneurysms (AAA), involving the exits of the renal and visceral arteries still constitutes a considerable challenge. Many different techniques have been developed over the years in attempts to surmount the difficulties presented by these cases. Techniques that have gained prominence include fenestrated or branched stents, methods involving parallel prostheses, such as the chimney, periscope and sandwich techniques, and, more recently, flow modulation with Multilayer stents. We describe a case of a complex juxtarenal saccular AAA with a high surgical risk, both according to cardiological assessment and because the patient had a difficult airway caused by a total laryngectomy for early stage laryngeal neoplasm. In view of the technical simplicity of using Multilayer stents, the presence of chronic obstructive aortoiliac disease, ostial stenosis of the renal artery and a small diameter suprarenal aorta, options involving fenestrated/branched stents and techniques involving parallel prostheses were ruled out, because of the need for multiple accesses. In view of the dilemma it presented, we describe this case as a therapeutic challenge and present the treatment option employed, which has been successful over the short term.
Highlights
Endovascular treatment of abdominal aortic aneurysms (AAA) that involve the exits of the renal and visceral arteries is a considerable challenge, in patients at high surgical risk
We describe the case of patient with very high cardiological surgical risk and multiple comorbidities suffering from a juxtarenal saccular AAA
Vascular access was limited by chronic obstructive aortoiliac disease and by hostile neck anatomy, caused by cervical lymph node dissection, laryngectomy and cervical radiotherapy, in addition to ostial stenosis of the left renal artery, throwing up technical obstacles to execution of options involving branched and fenestrated stents or parallel prostheses
Summary
Endovascular treatment of abdominal aortic aneurysms (AAA) that involve the exits of the renal and visceral arteries is a considerable challenge, in patients at high surgical risk. Several alternative techniques to conventional surgery have been developed over the years in attempts to surmount the difficulties presented by these cases. Vascular access was limited by chronic obstructive aortoiliac disease and by hostile neck anatomy, caused by cervical lymph node dissection, laryngectomy and cervical radiotherapy, in addition to ostial stenosis of the left renal artery, throwing up technical obstacles to execution of options involving branched and fenestrated stents or parallel prostheses. In view of the dilemma it presented, we describe this case of a therapeutic challenge and the treatment option employed, which has proved successful in the short term
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