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International Angiology 2020 Nov 03

DOI: 10.23736/S0392-9590.20.04457-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Staged in situ aorto-iliac hybrid technique: an original technique to treat complex juxtarenal and iliac aneurysms

Emiliano CHISCI , Clara PIGOZZI, Aldo ALBERTI, Fabrizio MASCIELLO, Nicola TROISI, Filippo TURINI, Stefano MICHELAGNOLI

Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy


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BACKGROUND: To report a novel staged hybrid technique to treat complex juxtarenal abdominal aortic aneurysm (JAAA) associated with at least one iliac artery aneurysm (IA) with no adequate distal fixation zone.
METHODS: The novel technique herein described has two main “staged” steps. The first step consists in create an adequate distal fixation zone by endovascular means; after hypogastric embolization an iliac stent-graft has placed from 5 mm above the aortic bifurcation to the external iliac artery. The second step is the surgical resection of the JAAA and graft placement sutured distally to the stent-graft which was always performed the day after.
RESULTS: The five cases included (mean age 74 years), were rejected for fenestrated or branched endovascular aortic repair or iliac branch devices. Four tube grafts and one aorto-bi-iliac graft were sutured to one stent-graft (n=3), two stent-grafts in iliac kissing configuration (n=1) and to a main body of a bifurcated stent-graft (n=1). Mean followup duration was 14 (4-27) months with no mortality. Technical success was obtained in all cases (2 suprarenal clamping). Postoperative complications included two pleural effusions, two transient gluteal intermittent claudications, and one renal failure.
CONCLUSIONS: The technique herein described seems to be a feasible and cost-effective alternative treatment for selected concomitant complex JAAAs and IAs unsuitable for totally endovascular treatment.


KEY WORDS: Juxtarenal aneurysm; Iliac aneurysm; Aorto iliac aneurysm; Endovascular repair; Open repair; hybrid repair; Staged procedures

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