Endovascular management of complicated AAA

复杂腹主动脉瘤的腔内修复治疗Department of Vascular Surgery, Xiang-Ya Second Hospital, Central-South University

中南大学湘雅二 医院血管Chang Shu 舒 畅

Case one

Severe calcification + tortuosity

Case one

• Male

• 73 years old

• Severe calcification in the abdominal aorta and bilateral iliac As.

• There is a sharp angle (≈80°) between the abdominal A and the right iliac artery. And the proximal neck is very tortuous.

Pre-operation

treatment

A stiff guide wire was utilized to straighten the sharp angle between the abdominal aorta and the right iliac A.

Post-operation

Post-operation

Case two

Tuberculous mycotic abdominal aortic pseudo-aneurysm

• Female

• 52 years old

• Fever for 2 weeks. X-ray indicated TB.

• Abrupt abdominal pain, especially in the medial and back.

Case two

CTA pre-operation

CTA pre-operation

CTA pre-operation

MRI pre-operation

treatment

• Conservative anti-tuberculosis therapy was used before admission, and the symptoms relieved.

• EVAR was then performed to repair the pseudo-aneurysm.

Follow-up

Follow-up

• The pseudo-aneurysm was totally excluded by stent graft.

• No migration, infection of the stent graft, endoleak and so on.

• All symptoms relieved.

Discussion

• Conservative anti-tuberculosis therapy alone is insufficient to tuberculous mycotic abdominal aortic aneurysm/pseudo-aneurysm.

• Medication associated with surgery is appropriate.

Discussion

• Open surgery, such as prosthesis graft bypass, extra-anatomic bypass, also can be used.

• EVAR is a good alternative for Tuberculous mycotic abdominal aortic pseudo-aneurysm.

Case three

Severe torque of the iliac artery

Severe torque of the iliac artery is not a problem.

Case four

Single arm AAA stent-graft

Single arm AAA stent-graft

Case five

Severe torque of the iliac artery

Severe torque of bilateral iliac As

Severe torque of bilateral iliac As

Case six

Short proximal neck

AAA case with the proximal neck less than 0.5 cm, and tortuous proximal site.

AAA case with the proximal neck less than 0.5 cm, and tortuous proximal site.

EVAR

Case seven

Associated with giant iliac artery aneurysm and several tortuous site

CT pre-operation

CTA pre-operation

•Severely tortuous in the proximal site.

•Bilateral common iliac aneurysm, especially the left one, associated with bilateral internal iliac arteries.

•Severe tortuosity of the right common iliac artery.

CTA pre-operation

•Severely tortuous in the proximal site.

•Bilateral common iliac aneurysm, especially the left one, associated with bilateral internal iliac arteries.

•Severe tortuosity of the right common iliac artery.

• Because of the hemodynamic and anatomic reasons, angiography of the left iliac artery was not achieved.

• So, DSA had to be performed to indentify the definite situation.

DSA

DSA

DSA

Case eight

Giant AAA associated with several tortuous site

Two stiff guide wires were utilized to straighten the sharp angle of the left iliac artery.

Case night

Giant AAA associated with several tortuous site

Discussion

Discussion

How to make the decision: open surgery or endoluminal technique?

1. the location and anatomic conditions of the aneurysm.

2. the condition of the patient: age, co-morbidity and so on.

3. financial support.

Thank you very much!