Abstract
Endovascular aortobifemoral bypass repair with aortic bifurcation reconstruction is a well-established option with mortality benefits compared to conventional surgical management. The same theory, formulas, and techniques can be applied to the central venous system as long as there are commercially available devices. Using mathematically derived criteria for optimal stent size selection, endovascular aortic bifurcation reconstruction with kissing stents was extrapolated to the inferior vena cava (IVC). This report describes a traumatic case of IVC injury that was successfully repaired using the standard aortic grafts while adhering to the guidelines for proper stent size selection.
Highlights
Arteriosclerotic vascular disease (ASVD) progression varies between patients and is treated based on the severity of manifestations
In the case of a diseased aortoiliac bifurcation in ASVD, or an inferior vena cava (IVC) that has undergone vessel trauma, the diameter of the native vessel lumen is the first step in a sequence that will determine the "kissing" or side-by-side stent sizes to be deployed in the iliac arteries and veins, respectively
The Matteo mathematics method was extended from the arterial to the venous system to achieve satisfactory IVC reconstruction with good flow and resolution of contrast extravasation
Summary
Arteriosclerotic vascular disease (ASVD) progression varies between patients and is treated based on the severity of manifestations. In the most severe cases, revascularization of the lower extremities secondary to aortoiliac ASVD involves major intra-abdominal surgery with aortobifemoral bypass grafting. Endovascular aortobifemoral bypass repair with aortic bifurcation reconstruction has recently become a conventional interventional procedure, offered to patients who are not appropriate surgical candidates [2]. In the case of endovascular aortic repair, a subset of patients with ASVD has small caliber vessels, rendering repair of the aorta and iliac arteries incompatible with the available endovascular stent grafts [3]. To enable endovascular treatment of such patients, a novel percutaneous piecemeal stent graft placement technique was described by Matteo et al This technique utilized individual placement of the device components to circumvent the size limitations of the available deployment systems. A mathematical method was derived for the selection of an ideal stent graft size to avoid infolding and endoleaks [5]
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