TCTAP C-178 Bailout Solution for AAA with Acute Neck and Renal Artery Stenosis

[Clinical Information] Patient initials or identifier number Mrs. NHT Relevant clinical history and physical exam Mrs. NHT, a 65 year old lady, admitted due to abdominal pain and hypogastric pulsatile mass Her CVD risk factors were untreated hypertension and hypercholesterolemia Her blood test resul...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2015-05, Vol.65 (17), p.S381-S383
Main Authors: Nguyen, Quang Ngoc, Le, Than Xuan
Format: Article
Language:English
Subjects:
Cardiology
Cardiovascular
Internal Medicine
Intubation
Medical treatment
Military personnel
Military strategy
Veins & arteries
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Summary:[Clinical Information] Patient initials or identifier number Mrs. NHT Relevant clinical history and physical exam Mrs. NHT, a 65 year old lady, admitted due to abdominal pain and hypogastric pulsatile mass Her CVD risk factors were untreated hypertension and hypercholesterolemia Her blood test results were nearly normal Her resting EKG showed no specific ST changes Her echocardiography showed normal LV EF Relevant test results prior to catheterization MSCT findings showed big AAA with very angulate neck Relevant catheterization findings Endovascular approach for this symptomatic AAA was decided First angio image confirmed MSCT images [Interventional Management] Procedural step AAA stent graft (23-16*200) and two iliac branches (16-13*160 and 16-13*90) Two very stiff wire was applied to reduce the angulation between the neck and long axis of the AAA Main body of stent graft (23-16*200) was deployed just below the renal artery However, due to the angulation, the stent graft miss the landing zone and endoleak type I was dominant Two other distal branches were used to cover both internal iliac artery Balloon dilatation was applied to reduce the proximal endoleak and optimize the results but nothing changes much Proximal extension piece was deployed to minimize the endoleak and enlarger the landing zone The left renal artery was stenosis and PTA/stent to left renal artery was applied though left radial very Case Summary Very angulate neck of AAA could result in missing landing zone for main body of AAA Bailout PTA/stent to left renal artery was used to protect renal perfusion while extending the length of landing zone
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2015.03.462