Ventana fenestrated stent-graft system for endovascular repair of juxtarenal aortic aneurysms

摘要

Purpose: To describe the initial use of an off-the-shelf fenestrated stent-graft system for endovascular repair of juxtarenal abdominal aortic aneurysms. Technique: The off-the-shelf Ventana fenestrated stent-graft system consists of a 25-mm IntuiTrak self-expanding bifurcated stent-graft implanted at the aortic bifurcation. A Ventana self-expanding fenestrated proximal extension stent-graft is overlapped with the bifurcated body distally and sealed proximally in the visceral segment with a 4-cm-long scallop below and around the SMA and celiac artery, obviating the need for an infrarenal neck. Movable, non-reinforced, 3-mm fenestrations for the renal arteries can be expanded to 10 mm. The 22-F delivery system includes 6.5-F guide sheaths pre-inserted through the stent-graft fenestrations so that the renal arteries are cannulated before the fenestrated stent-graft is deployed. The Xpand renal stent-grafts, with a proximal segment intended for flaring in the aorta, are delivered on 5-F or 6-F balloon catheters through the 6.5-F guide sheaths. The technique is illustrated in 2 patients (76 and 77 years of age) with significant comorbidities and juxtarenal aortic aneurysms measuring 5.9 and 7.4 mm, respectively, who were enrolled in an ongoing prospective trial (www.ClinicalTrials.gov identifier NCT01348828) of this new device. Patient 1 had a 28-mm fenestrated stent-graft system with the aligned fenestration configuration deployed, while the stent-graft in Patient 2 was 32 mm in diameter and had offset fenestrations to accommodate the renal artery geometry. Mean fluoroscopy times were 27 and 35 minutes, and the contrast volumes were 72 and 67 mL. Total procedure times were 84 and 71 minutes. The aneurysms were effectively excluded in uneventful procedures, with no migration, endoleak, or renal dysfunction at 6-month follow-up. Conclusion: There exists an unmet clinical need for a broadly applicable endovascular option for repair of more complex juxtarenal or pararenal aortic aneurysms. These cases suggest that endovascular repair of such aneurysms using the Ventana fully integrated off-the-shelf stent-graft system is safe and feasible.