c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Explantation of Aortic Endograft for Type I Endoleak: 4

A D V E R T I S E M E N T

   
 

The endoleak cavity was selectively catheterized with a Sos catheter. Digital subtraction angiography in the lateral projection clearly demonstrates a posterior Type I endoleak at the proximal fixation point. The lumbar artery visualized on the AP view is again seen. The endoleak was not amenable to endovascular correction due to proximity to the renal artery and gross deformity of the endograft.      

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Explantation of Aortic Endograft for Type I Endoleak: 5

A D V E R T I S E M E N T

   
 

The patient was brought to the operating room for endograft explantation and conversion to open aneurysm repair. The abdominal aorta was exposed through a midline transperitoneal approach. The aorta is shown here with the left renal vein crossing over it (straight arrow). The inferior mesenteric artery had brisk backbleeding and therefore was ligated at the abdominal aorta (curved arrow). Ligation of the IMA is performed flush with the aortic wall to preserve important collateral flow to the hindgut and pelvis. The retroperitoneal tissue overlying the aortic bifurcation was moderately inflamed.     

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Explantation of Aortic Endograft for Type I Endoleak: 6

A D V E R T I S E M E N T

   
 

There was inadequate infrarenal aorta to clamp below the renals and above the endograft. The initial clamp placement was above the right renal artery but below the left renal artery (see angiogram). The aneurysm sac was opened and the endograft was exposed. Using gentle axial traction, the proximal graft was delivered into the sac. The lack of external support or hooks with this particular device (AneuRx) made this maneuver technically easy to perform. Once the proximal endograft was detached, the aortic clamp was moved down to an infrarenal position. Since there was no distal endoleak, backbleeding was entirely within the endograft lumen.     

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This page was last modified on 11/12/2004.