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Endovascular management of the juxtarenal aortic aneurysm: can uncovered stents safely cross the renal arteries?

Malina, Martin LU ; Brunkwall, J; Lindblad, Bengt LU ; Resch, Tim LU and Ivancev, Krassi LU (1999) In Seminars in Vascular Surgery 12(3). p.182-192
Abstract
A short or otherwise suboptimal neck precludes the use of endovascular repair in 30% to 50% of patients with abdominal aortic aneurysms. Stent-graft fixation in an unsuitable neck carries the risk of technical failure owing to development of a proximal endoleak or stent-graft migration. Furthermore, in some patients, the neck dilates postoperatively. Endovascular healing with tissue incorporation into the graft material seems in and of itself insufficient to fixate the stent-graft adequately or to prevent neck dilation. Therefore, neck dilation is often associated with detachment of the stent-graft from the aortic wall, which is followed by the development of a proximal endoleak or stent-graft migration. Fixation of stent-grafts can be... (More)
A short or otherwise suboptimal neck precludes the use of endovascular repair in 30% to 50% of patients with abdominal aortic aneurysms. Stent-graft fixation in an unsuitable neck carries the risk of technical failure owing to development of a proximal endoleak or stent-graft migration. Furthermore, in some patients, the neck dilates postoperatively. Endovascular healing with tissue incorporation into the graft material seems in and of itself insufficient to fixate the stent-graft adequately or to prevent neck dilation. Therefore, neck dilation is often associated with detachment of the stent-graft from the aortic wall, which is followed by the development of a proximal endoleak or stent-graft migration. Fixation of stent-grafts can be improved by placing the proximal stent above one or both of the renal artery orifices. Current experimental and clinical data suggest that renal function is not impaired by suprarenal aortic stents during the first year; however, this finding may not apply to all types of stents. Fixation of stent-grafts also may be improved by using stents with barbs that pierce the aortic wall. Additionally, the force that is exerted on the anchoring device may well be reduced by fully stented grafts with an associated increase in column strength. In the future, the risk of neck dilation and stent-graft dislodgement might also be limited by novel techniques such as laparoscopic banding of the neck or endoluminal stapling devices. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Seminars in Vascular Surgery
volume
12
issue
3
pages
182 - 192
publisher
W B Saunders
external identifiers
  • pmid:10498261
  • scopus:0032823370
ISSN
0895-7967
language
English
LU publication?
yes
id
2a038a4a-1287-4f62-8e07-684a228447ac (old id 1114263)
date added to LUP
2008-07-03 15:53:42
date last changed
2017-01-01 06:41:36
@article{2a038a4a-1287-4f62-8e07-684a228447ac,
  abstract     = {A short or otherwise suboptimal neck precludes the use of endovascular repair in 30% to 50% of patients with abdominal aortic aneurysms. Stent-graft fixation in an unsuitable neck carries the risk of technical failure owing to development of a proximal endoleak or stent-graft migration. Furthermore, in some patients, the neck dilates postoperatively. Endovascular healing with tissue incorporation into the graft material seems in and of itself insufficient to fixate the stent-graft adequately or to prevent neck dilation. Therefore, neck dilation is often associated with detachment of the stent-graft from the aortic wall, which is followed by the development of a proximal endoleak or stent-graft migration. Fixation of stent-grafts can be improved by placing the proximal stent above one or both of the renal artery orifices. Current experimental and clinical data suggest that renal function is not impaired by suprarenal aortic stents during the first year; however, this finding may not apply to all types of stents. Fixation of stent-grafts also may be improved by using stents with barbs that pierce the aortic wall. Additionally, the force that is exerted on the anchoring device may well be reduced by fully stented grafts with an associated increase in column strength. In the future, the risk of neck dilation and stent-graft dislodgement might also be limited by novel techniques such as laparoscopic banding of the neck or endoluminal stapling devices.},
  author       = {Malina, Martin and Brunkwall, J and Lindblad, Bengt and Resch, Tim and Ivancev, Krassi},
  issn         = {0895-7967},
  language     = {eng},
  number       = {3},
  pages        = {182--192},
  publisher    = {W B Saunders},
  series       = {Seminars in Vascular Surgery},
  title        = {Endovascular management of the juxtarenal aortic aneurysm: can uncovered stents safely cross the renal arteries?},
  volume       = {12},
  year         = {1999},
}