Erol ŞENER, Mete HIDIROĞLU, Murat CANYİĞİT, Emrah UĞUZ, Ali ÇAM, Muhammet Fethi SAĞLAM, Hüseyin ÇETİN, Tülin GÜMÜŞ

Endovascular repair of type-V thoracoabdominal aortic aneurysms using parallel graft techniques

Amaç: Bu çalışmada renoviseral arterlerin kan akımının devamını sağlamak için tip-V torakoabdominal aort anevrizmalarının paralel greftler kullanılarak endovasküler aort tamirinin orta dönem sonuçları sunuldu.Ça lış ma pla nı: Mart 2013 - Mart 2014 tarihleri arasında tip-V torakoabdominal aort anevrizması olan ardışık dört hastaya (3 erkek, 1 kadın; ort. yaş 66.8 yıl, dağılım 63-73 yıl) paralel greftler kullanılarak endovasküler aort tamiri yapıldı. Baca ve sandviç greftler aksillobrakiyal erişim ile yerleştirilirken, periskop greftler ve aortik endogreftler transfemoral erişim ile yerleştirildi.Bul gu lar: Ortalama takip süresi 16.25 ay idi. Tüm aortik stent-greftler ve paralel greftler %100 işlem başarısıyla yerleştirildi. Aort anevrizmaları torasik endogreftler (n=11) ve bir bifurke stent-greft kullanılarak dışarıda bırakıldı. Sekiz renal ve sekiz viseral arterin kan akımını sağlamak için toplam 16 paralel greft (8 sandviç greft, 2 baca greft, ve 6 periskop greft) 26 Viabahn® kaplı stent kullanılarak yerleştirildi. Bir hastanın böbrek fonksiyonunda geçici kötüleşme görüldü. Takip sırasında dört hastanın üçünde sorun görülmedi ve bir hastada ameliyat sonrası birinci ayda subdural hematom gelişti. Hastaların hiçbirinde ameliyat sonrası mortalite gözlenmedi. Anevrizmada büyüme saptanmadı. Tüm paralel greftler açıktı. Kısa dönem takipte iki hastada minimal tip I ve tip III endo kaçaklar gözlendi.So nuç: Paralel greft tekniği, tip-V torakoabdominal aort anevrizmalarının tedavisinde çok düşük mortalite oranları ile kullanışlı ve daha az invaziv alternatif bir yöntemdir.

Paralel greft teknikleri kullanılarak tip-V torakoabdominal aort anevrizmalarının endovasküler tamiri

Background: This study aims to present mid-term outcomes of endovascular aortic repair of type-V thoracoabdominal aortic aneurysms using parallel grafts to maintain blood flow to renovisceral arteries.Methods: Between March 2013 and March 2014, four consecutive patients (3 males, 1 female; mean age 66.8 years; range 63 to 73 years) with type-V thoracoabdominal aortic aneurysms underwent endovascular aortic repair with parallel grafts. Chimney and sandwich grafts were inserted from an axillobrachial access, while periscope grafts and aortic endografts were delivered via transfemoral access.Results: The mean follow-up was 16.25 (range 9 to 22) months. All aortic stent-grafts and parallel grafts were implanted with 100% procedural success. The aortic aneurysms were excluded with thoracic endografts (n=11) and a bifurcated stent-graft. A total of 16 parallel grafts (8 sandwich grafts, 2 chimney grafts, and 6 periscope grafts) using 26 Viabahn®coated stents were placed to maintain blood flow to eight renal and eight visceral arteries. Temporary worsening of kidney function was seen in a patient. During follow-up, three of the four patients were uneventful and a subdural hematoma developed in a patient in the first postoperative month. No postoperative mortality was seen in any patient. No aneurysmal growth was seen. All parallel grafts were patent. Minimal type-I and type-III endoleaks were observed in two patients with short-term follow-up.Conclusion: The parallel graft technique to treat type-V thoracoabdominal aortic aneurysms is a feasible and less invasive alternative method with extremely low mortality rates.

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