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2015 ; 32
(3
): 289-303
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Advanced Endovascular Approaches in the Management of Challenging Proximal Aortic
Neck Anatomy: Traditional Endografts and the Snorkel Technique
#MMPMID26327748
Quatromoni JG
; Orlova K
; Foley PJ 3rd
Semin Intervent Radiol
2015[Sep]; 32
(3
): 289-303
PMID26327748
show ga
Advances in endovascular technology, and access to this technology, have
significantly changed the field of vascular surgery. Nowhere is this more
apparent than in the treatment of abdominal aortic aneurysms (AAAs), in which
endovascular aneurysm repair (EVAR) has replaced the traditional open surgical
approach in patients with suitable anatomy. However, approximately one-third of
patients presenting with AAAs are deemed ineligible for standard EVAR because of
anatomic constraints, the majority of which involve the proximal aneurysmal neck.
To overcome these challenges, a bevy of endovascular approaches have been
developed to either enhance stent graft fixation at the proximal neck or extend
the proximal landing zone to allow adequate apposition to the aortic wall and
thus aneurysm exclusion. This article is composed of two sections that together
address new endovascular approaches for treating aortic aneurysms with difficult
proximal neck anatomy. The first section will explore advancements in the
traditional EVAR approach for hostile neck anatomy that maximize the use of the
native proximal landing zone; the second section will discuss a technique that
was developed to extend the native proximal landing zone and maintain perfusion
to vital aortic branches using common, off-the-shelf components: the snorkel
technique. While the techniques presented differ in terms of approach, the
available clinical data, albeit limited, support the notion that they may both
have roles in the treatment algorithm for patients with challenging proximal neck
anatomy.