Case

A Case of Endovascular Aneurysm Repair for Treatment of Abdominal Aortic Aneurysm Using Antegrade Wiring via Radial Access

- Operator : Bong-Ki Lee

A Case of Endovascular Aneurysm Repair for Treatment of Abdominal Aortic Aneurysm Using Antegrade Wiring via Radial Access
- Operator: Bong-Ki Lee, MD
Clinical Information
- Relevant clinical history and physical examination:
A 78 year old man was admitted for endovascular aneurysm repair of known abdominal aortic aneurysm. His risk factor was hypertension. He presented with dull lower abdominal pain. A pulsatile mass was palpated at lower abdomen. There was no ischemic symptom at lower extremities.

- Relevant test results prior to catheterization:
His visited seven month ago at first for lower abdominal pulsating mass. An ultrasonogram showed an abdominal aortic aneurysm with dimension of 43mm. Because, there was no related symptom and the dimension was not so big to repair by guidelines, he was followed up with anti-hypertension and anti-platelet therapy without interventional or surgical repair. Six month later, he took an abdominal CT scan and the largest diameter was measured to 47mm (Figure 1, Figure 2). Then, he began to complain lower abdominal dull pain. For rapid enlargement of the AAA and newly developed symptom, we planed endovascular repair.

- Relevant catheterization findings:
The concurrent coronary angiography showed no significant coronary stenosis. Abdominal aortogram showed fusiform dilatation of abdominal aorta extended to both common iliac arteries ( Movie 1).

Interventional Management
- Procedural step:
Surgical cut down was performed at both femoral arteries for vascular access. A SEAL bifurcated stent graft (26/12 x 80/60mm, S&G Biotech INC, Seongnam-si, Korea; Figure 3, Figure 4) was inserted via right femoral cut down site and deployed at just above take off of renal arteries (Figure 5). Then, a SEAL extension stent graft (12/22 x 110mm) was inserted via same site and deployed to extend from the bifurcation graft to right common iliac artery sealing the aneurysm (Figure 6). We tried to pass a 0.035 inch Terumo guide wire into the left branch of the bifurcation stent graft via left cut down site for introducing left extension stent graft. But, due to the extremely tortuous left common iliac artery, wire passing was failed (Figure 7). So, right radial artery was punctured and a 0.035 inch long Terumo wire was inserted through the right radial access site and antegradely introduced toward ostium of the left common iliac artery. Then the wire tip was captured by a 20mm snare catheter in pulled out to the left femoral access site ( Movie 2). We introduced a guiding catheter over the Terumo wire and inserted another extension stent graft into the left branch of the bifurcation stent graft (Figure 8). The stent graft was deployed and several adjunctive balloon dilatations were performed for complete opposition (Figure 9, Figure 10). The Final angiogram showed successful result ( Movie 3, Movie 4).

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