title: First application of the ‘lasso technique’ on an endograft with suprarenal fixation stent.
abstract: The authors report the use of the ‘lasso technique’ for the preservation of bilateral renal artery patency, following the intraoperative proximal migration of an aortic endograft with suprarenal bare metal fixation and anchoring barbs, due to device delivery failure.During an emergency endovascular repair of a ruptured mycotic abdominal aortic aneurysm using the Zenith Flex device, the main body of the graft migrated proximally to cover both renal arteries. Attempts to pull down the graft using balloons were not effective.Finally, the ‘lasso technique’ using a guidewire over the aortic bifurcation was employed and successfully adjusted the graft below the level of the renal arteries. No procedure-related complications were noted. The endovascular repair was used as a bridging procedure and two months following the primary endovascular procedure, open surgical repair of the infected aneurysm with excision of the stent graft was performed. The patient is alive after eight months follow-up.
authors.affiliation: Department of Interventional Radiology, Guy's and St Thomas’ NHS Foundation Trust, King's Health Partners, London SE1 7EH, UK. stavspiliop@upatras.gr
authors.forename: Stavros
authors.initials: S
authors.lastname: Spiliopoulos
authors.forename: Kevin
authors.initials: K
authors.lastname: Mani
authors.forename: Tarun
authors.initials: T
authors.lastname: Sabharwal
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Krokidis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Gkoutzios
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000382:microbiology / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000382:microbiology / Q000601:surgery; D001019:Aortic Rupture / Q000382:microbiology / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D020878:Device Removal; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome