Cook Fenestrated Endografts Can Be Combined With Gore Iliac Bifurcation Grafts To Treat Pararenal Aneurysms Associated With Iliac Artery Aneurysms
Ritu Aparajita, MBBS, Joel Crawford, MD, Cindy Sturt, MD, Bruce Brener, MD.
Newark Beth Israel Medical Center, Newark, NJ, USA
DEMOGRAPHICS: 68 year old male
HISTORY: The above patient presented with 8 cm juxta-renal aortic aneurysm and concomitant bilateral large common iliac aneurysms for repair. His past medical history included hypertension, coronary artery disease and hyperlipidemia. Medications included aspirin, carvedilol, and pravastatin. He had smoked for fifty years. Family history was significant for hypertension and coronary artery disease. Abdominal examination revealed widened pulsatile mass in the epigastrium. His peripheral pulses were palpable. CT scan (Figure 1a) revealed an 8cm juxta-renal aneurysm, short infrarenal neck, and significant aortic and iliac tortuosity. There were bilateral common iliac artery aneurysms measuring 3.8cm on the left and 4 cm on the right.
PLAN: The left hypogastric artery was initially embolized with 12mm Cook Nestor coils. Three weeks later utilizing a percutaneous approach a Cook Zenith fenestrated Endograft (main body 30x94) with two small renal fenestrations and a scallop for the superior mesenteric artery was placed proximally. Two covered renal stents were inserted. Then the Gore iliac Bifurcation Graft (IBG) was inserted via the right femoral and the right hypogastric artery extension was delivered from the left femoral. A Gore Excluder bifurcation stent graft was placed within the proximal fenestrated main body through the left femoral artery. A connecting Gore iliac extension joined the Excluder to the IBG (Figure1b). The patient recovered from the procedure and was discharged home on post-operative day 3. One month later, his follow up CT scan (Figure 1c) showed exclusion of the aortic and iliac aneurysms ,no endoleaks, and patency of all branches.
DISCUSSION: Alternative strategies including parallel grafts, bilateral iliac coil embolization and use of endostaples were entertained and will be discussed.
Figure 1a showing 8cm juxtarenal aneurysm with concomitant bilateral common iliac artery aneurysms measuring 3.8cm on the left and 4 cm on the rightFigure 1b : completion angiogram with exclusion of aneurysms and no endoleaks Figure 1c Follow up CT scan showing exclusion of abdominal aortic and iliac aneurysms, no endoleaks and patency of all visceral branches
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