Abstract
Background: The Endovascular Repair (EVAR) is the first-choice technique for Abdominal Aortic Aneurysm (AAA). Treatment success is dependent on favorable anatomy and an adequate sealing zone formed by a straight aortic neck (slightly angled). Endoprostheses implanted at critical aortic angles (above 75º) may result in unfavorable results such as fracture, migration, and type Ia endoleak. The technique for creating a proximal “Neoneck” consists of implanting the Palmaz stent in the proximal neck of the AAA, before placement of the endoprosthesis, allowing remodeling and rectification of the aortic neck.
Objectives: To describe the “Neoneck” technique and report the early results of three cases with rectification of the proximal neck angle using a Palmaz stent, enabling treatment in these cases with angulated necks.
Methods: We analyzed data collected from patients in whom Palmaz stents were placed, constructing a proximal Neoneck, during EVAR for infrarenal AAA with very tortuous proximal aortic neck, assessing anatomy, devices and perioperative results, including success rates, complications, mortality, and patency in the short and medium term.
Results: All patients presented satisfactory evolution with immediate technical success. There were no cases of migration, fracture, or type Ia endoleaks. There was evidence of aneurysmal sac reduction after six months. There were no complications related to surgical access or deaths.
Conclusions: In cases of angled aortic necks, when open AAA repair is not possible, in the absence of ideal devices or in urgent cases, prior rectification of the aortic neck deploying the Palmaz stent is feasible and effective. Long-term studies are still needed to validate the technique and assess safety.
Keywords
endovascular aortic repair; infrarenal abdominal aortic aneurysm; tortuous neck; hostile neck; proximal neoneck; Palmaz stent
Resumo
Contexto: O reparo endovascular do aneurisma de aorta abdominal infrarrenal (EVAR) representa hoje a técnica de escolha inicial. O sucesso terapêutico depende de anatomia favorável e adequada zona de selamento, formada por um colo reto (pouco angulado). Endopróteses implantadas em angulações críticas (acima de 75º) podem resultar em resultados desfavoráveis como fratura, migração e endoleak tipo 1A. A técnica de confecção de um “Neocolo” proximal consiste no implante do stent Palmaz no colo proximal do AAA de forma primária no mesmo tempo cirúrgico, antes da colocação da endoprótese, permitindo o remodelamento e a retificação do colo aórtico.
Objetivos: Descrever a técnica de “Neocolo” e relatar resultados iniciais em três casos de EVAR com retificação da tortuosidade do colo proximal com o uso de stent Palmaz, viabilizando o tratamento nos casos de colos proximais muito angulados.
Métodos: Dados foram coletados de pacientes submetidos à técnica de Neocolo durante EVAR para AAA infrarrenal com colo proximal, avaliando anatomia, dispositivos e resultados perioperatórios.
Resultados: Todos os pacientes apresentaram evolução satisfatória com sucesso técnico imediato. Não houve casos de migração, fratura e/ou endoleak 1A. Houve evidência de redução do saco aneurismático após 6 meses. Não houve complicações relacionadas ao acesso cirúrgico e/ou óbitos.
Conclusões: Em casos de colos muito tortuosos, na impossibilidade do reparo aberto do AAA, na ausência de dispositivos dedicados ou em casos de urgência, a retificação prévia do colo com o stent Palmaz é viável e eficaz. Estudos a longo prazo ainda são necessários para validação da técnica e avaliação da segurança.
Palavras-chave
reparo aórtico endovascular; aneurisma de aorta abdominal infrarrenal; colo tortuoso; colo hostil; Neocolo proximal; Palmaz
Referências
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