Snorkel Technique for Inferior Mesenteric Artery During Endovascular Repair of Abdominal Aortic Aneurysm

• Published in: Vascular and endovascular surgery 2018-04, Vol.52 (3), p.233-236
• Main Authors: Ertugay, Serkan, Daylan, Ahmet, Bozkaya, Halil, Oğuz, Emrah, Apaydın, Anıl, Parıldar, Mustafa, Posacıoğlu, Hakan
• Format: Article
• Language: English
• Subjects: Aged; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - physiopathology; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Computed Tomography Angiography; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Humans; Male; Mesenteric Artery, Inferior - diagnostic imaging; Mesenteric Artery, Inferior - physiopathology; Mesenteric Artery, Inferior - surgery; Prosthesis Design; Splanchnic Circulation; Stents; Treatment Outcome; Vascular Patency
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574418758597

Purpose: The snorkel technique is commonly used to preserve renal arteries in juxta renal aneurysm during endovascular repair. Herein, we present a patient who underwent bifurcated endograft implantation with snorkel technique for inferior mesenteric artery (IMA) in order to preserve the major source of bowel circulation. Case Report: A 69-year-old male patient was diagnosed with abdominal aortic aneurysm. His history revealed that he had bowel resection due to a car accident 30 years ago. In addition, he was given relaparotomy 4 times due to intestinal complications. Computed tomography showed fusiform aneurysm with a maximal diameter of 60 mm and chronical occlusion of the superior mesenteric artery. Inferior mesenteric artery was found to be hypertrophic. During EVAR, 6 mm × 10 cm covered VIABAHN Endoprosthesis (Gore Medical) was implanted to the IMA over a 0.018 guidewire via puncture of the left axillary artery. Initially, the main body of the aortic stent-graft (Gore C3, size 23-14-16) was implanted to the infra renal segment of the aorta (below the renal arteries and the orifice using VIABAHN) via the right femoral artery. Next, the contralateral leg (Gore, 14-12-00) was implanted. Computed tomography was examined at 1- and 32-month postoperatively, and no endoleak or patency of IMA stent was detected. Conclusion: In this case of IMA-dependent circulation of the intestinal system, the protection of IMA via snorkel technique was successful.