Physician modified endograft to treat a symptomatic juxta-renal aortic aneurysm: report of the first case at our center
DOI:
https://doi.org/10.48750/acv.639Abstract
BACKGROUND: Symptomatic or ruptured juxta-renal aortic aneurysms can be managed through open surgical repair or endovascular approaches, including chimney endovascular aortic repair (chEVAR), off-the-shelf branched devices, or physician-modified endograft (PMEG). PMEG has proven to be a feasible alternative with satisfactory long-term outcomes for such conditions.CASE REPORT: We document the inaugural case of PMEG performed at our center for a 69-year-old man with a symptomatic juxta-renal aortic aneurysm. This custom-made device included fenestrations for renal arteries and a scallop for the superior mesenteric artery. The patient was discharged home on the ninth postoperative day. A six-month follow-up CTA confirmed the AAA's exclusion, with maintained patency of all visceral vessels and no evidence of endoleak.
CONCLUSION: The complexity of the PMEG procedure varies based on the surgeon’s expertise and the patient’s anatomical challenges. This underscores the importance of meticulous patient selection, a process that ensures the safety and success of the procedure.
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References
Coselli JIS, Lemaire SA, Preventza O, De La Cruz KI, Cooley DA, Price MD, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016;151:323–35.
von Meijenfeldt CCI, Alberga AJ, Balm R, Vahl AC, Verhagen HJM, Blankensteijn JD, et al. Results from a nationwide prospective registry on open surgical or endovascular repair of juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2022;75:81–89:e5 .
Oderich GS, Farber MA, Schneider D, Makaroun M, Sanchez LA, Schanzer A, et al. Final 5-year results of the United States Zenith Fenestrated prospective multicenter study for juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2021;73:128–38.e2.
Tenorio ER, Dias-Neto MF, Lima GBB, Estrera AL, Oderich GS. Endovascular repair for thoracoabdominal aortic aneurysms: current status and future challenges. Ann Cardiothorac Surg. 2021;107:44–67.
Oderich GS, Tenorio ER, Mendes BC, Lima GBB, Marcondes GB, Saqib N, et al. Midterm Outcomes of a Prospective, Nonrandomized Study to Evaluate Endovascular Repair of Complex Aortic Aneurysms Using Fenestrated-Branched Endografts. Ann Surg [Internet]. 2021;274:491-9.
Chait J, Tenorio ER, Hofer JM, DeMartino BR, Oderich GS, Mendes BC. Five-year outcomes of physician-modified endografts for repair of complex abdominal and thoracoabdominal aortic aneurysms. J Vasc Surg. 2023;77:374-85.e4.
Tislimparis N, Gouveia e Melo R, Tenorio ER, Scali S, Mendes B, Han S, et al. Multicenter Study on Physician-Modified Endografts for Thoracoabdominal and Complex Abdominal Aortic Aneurysm Repair. Circulation. 2024;150:1327-42.
Tachida A, Stafforini N, Singh N, Starnes B, Zettervall SL. Reinterventions after physician-modified endovascular grafts for treatment of juxtarenal aortic aneurysms are non-detrimental to long-term survival. J Vasc Surg. 2023;77:1367-74.e2.
Taneva GT, Lee JT, Tran K, Dalman R, Torsello C, Fazzini S, et al. Long-term chimney/enovile endovascular aortic aneurysm repair experience for complex abdominal aortic pathologies within the PERICLES registry. J Vasc Surg. 2021;73:1942-9.
Scali ST, Beck AW, Torsello C, Lachat M, Kubilis P, Veith FJ, et al. Identification of optimal device combinations for the chimney endovascular aneurysm repair technique within the PERICLES registry. J Vasc Surg. 2018;68:24-35.
Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, et al. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aortic-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2024;67:192-331.
