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Endovascular management of pararenal aortic aneurysms with multiple overlapping uncovered stents  Yong-Xue Zhang, MD, Qing-Sheng Lu, MD, Jia-Xuan Feng,

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Presentation on theme: "Endovascular management of pararenal aortic aneurysms with multiple overlapping uncovered stents  Yong-Xue Zhang, MD, Qing-Sheng Lu, MD, Jia-Xuan Feng,"— Presentation transcript:

1 Endovascular management of pararenal aortic aneurysms with multiple overlapping uncovered stents 
Yong-Xue Zhang, MD, Qing-Sheng Lu, MD, Jia-Xuan Feng, MD, Zhi-Qing Zhao, MD, Jun-Min Bao, MD, Rui Feng, MD, Xiang Feng, MD, Zai-Ping Jing, MD  Journal of Vascular Surgery  Volume 58, Issue 3, Pages (September 2013) DOI: /j.jvs Copyright © 2013 Society for Vascular Surgery Terms and Conditions

2 Fig 1 A, A thoracic aortic pseudoaneurysm (white arrow) was found in a patient with a history of trauma. B, After treatment with three overlapping uncovered stents, the aneurysm (white arrow) was no longer patent at 6-month follow-up. C, A 5F selective catheter (black arrow) was placed into the aneurysmal sac during stent deployment to monitor sac pressure. D, Sac pressure was taken at 8 different locations: 1, the bottom of sac; 2 and 3, the shoulders of sac; 4 and 5, the waists of the sac; 6 and 7, the feet of the sac; and 8, the center of the sac. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

3 Fig 2 A, An infrarenal aortic ulcer (black arrow) was manifested on angiogram with a small-diameter distal landing zone. B, Residual perfusion of the aneurysm remained after stenting. C, At the 12-month follow-up, the residual perfusion was no longer present on the volume-rendered computed tomography image, whereas all covered lumbar arteries stayed patent (white arrows). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Measurement of aortic aneurysms. A, 1, Computed tomography angiography (CTA) revealed a large saccular aortic aneurysm involving the celiac trunk (white arrow). 2, The sac entrance (white arrow) was defined as the threshold between normal laminar flow of native aorta (red) and turbulent flow entering the aneurysmal sac (blue). 3, Its maximal length was measured parallel to the aortic center line, which was automatically generated by workstation software, using the “vessel analysis” function (black arrow). 4, The diameter of the aortic neck was measured 15 mm above the aneurysm perpendicularly to the center line (white arrow). B, 1, The preoperative maximal aneurysmal diameter was measured on the cross-sectional image, with (2) the slice's level documented using the vertebra as a marker (arrow). 3 and 4, Postoperative aneurysmal diameter was taken on the same slice (arrow). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

5 Fig 4 A patient with a new aneurysm within the stented zone. A, Prestenting angiography revealed a saccular aortic aneurysm in the renovisceral segment (black arrow). B, The aneurysm was treated with the combined use of multiple bare stents and coiling, and computed tomography angiography (CTA) before discharge revealed satisfactory exclusion. C, At the 3-month follow-up, a new aneurysm was detected above the original one (white arrow); thus, a reintervention was performed, adding two more stents to cover the new aneurysm. D, However, the CTA 3 months later revealed more aneurysms (white arrows). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Cumulative rate of aneurysmal sack thrombosis after treatment with multiple overlapped uncovered stents (MOUS). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Aneurysm diameter change after the treatment with multiple overlapping uncovered stents. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions


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