Endovascular Treatment of Abdominal Aortic Aneurysm Using a Branched Stent-Graft With Perfusion of the Adamkiewicz Artery

Abstract

Introduction:

Exclusion of long aortic segments in the treatment of endovascular thoracoabdominal aortic aneurysms is associated with a higher risk of spinal cord ischemia. We present the successful implantation of a branch stent graft with perfusion of the great Adamkiewicz artery to diminish risk of paraplegia.

Case Description:

An 81-year-old man was diagnosed with a perirenal aneurysm of the abdominal aorta (64 mm). Imaging examination revealed an Adamkiewicz artery with a diameter of 4.5 mm. Endovascular treatment was conducted using a customized branched stent graft with an additional branch to the Adamkiewicz artery, with access via the right femoral artery and the left axillary artery. After embolization of the inferior mesenteric artery, a stent graft was implanted, maintaining patency of the renal arteries, Adamkiewicz artery and visceral vessels.

Discussion:

This case demonstrates the effectiveness of personalized stent grafts adapted to the patient’s anatomy. The stent graft used, with a branch to the Adamkiewicz artery, allowed the aneurysm to be excluded from the circulation while maintaining spinal cord perfusion.

Conclusion:

In our opinion, such a solution should be considered in cases of extensive aortic aneurysms involving the large Adamkiewicz artery treated with branched endovascular aneurysm repair.

Clinical Impact

Presented case illustrates the potential of customized stent-grafts, which can be adapted to the patient’s anatomy. Spinal cord ischemia remains a significant complication of endovascular repair of aortic aneurysms. A prosthesis providing adequate perfusion of the Adamkiewicz artery may prove an additional method of preventing paraplegia. There is a paucity of literature on the repair of aortic aneurysms with the implantation of branched stent grafts with a branch into the Adamkiewicz artery, which serves to highlight the innovation of our treatment. The presented case offers new insights into the prevention of paraplegia with branched endovascular aneurysm repair procedures.