Multilayer Flow Modulator (MFM) Stent Insertion at Saccular Aneurysm in Peri-visceral Aorta: A Case Report.

Abstract

Introduction: To manage abdominal aorta aneurysm, especially supra-renal, open repair aorta surgery or EVAR with Chimney technique seemed evident until now. Multilayer Flow Modulator (MFM) is an effective and safe solution to achieve this problem and is the newest procedure for high-surgical-risk patients. We report our experience with MFM device for peri-visceral aorta aneurysm patient. Methods: A 67-year-old female with focal significant stenosis at right renal artery affected by 2.4 x 1cm saccular aneurysm in the peri-visceral aorta. Branched and fenestrated endovascular options were excluded because it is impossible in Korea, while the chimney technique was excluded due to its unattainability. Before the deployment of MFM stent, right renal artery angioplasty with 5mm x 19mm stent was done and the angiogram showed improved blood flow. Along with 3D reconstructed CT images, AneurysmFlowSM (Philips) angiogram was done in our Hybrid operating room. Then we successfully deployed a 25mm x 100mm MFM stent into the aorta and post-procedure AneurysmFlowSM angiogram was done. Results: Before the MFM deployment, AneurysmFlowSM angiogram showed complex turbulence of contrast dye along the aorta and this indicates that vorticity is presenting in the aneurysmal sac. Post-deployment AneurysmFlowSM showed slight but improved turbulent flow which is achieved by flow lamination. Renal arteries, including the one with a stent, show excellent blood flow without any defects. Post-operative complications like infection, stent thrombus and migration were not noted with 100% technical success. The patient showed a pre-operative eGFR of 74.7 mL/min and 96 mL/min postoperatively. Other laboratory findings remained normal and she was discharged 5 days after the procedure. Conclusion: The MFM can be utilized in high-surgical-risk patients with peri-visceral aortic as well as thoracoabdominal aortic aneurysms with safety. MFM is an alternative treatment approach to current devices with no long-term comparative data. Its effectiveness and ability to preserve collateral branches are an important aspect and randomized clinical trials are essential to becoming a viable alternative endovascular treatment.