Early experience with the endowedge technique and snorkel technique for endovascular aneurysm repair with challenging neck anatomy.
OBJECTIVE
This study was evaluating the outcomes of endovascular aneurysm repair (EVAR) using the endowedge technique (EnT) and/or snorkel technique (SnT) for abdominal aortic aneurysms (AAAs).


METHODS
The patients treated with EnT and/or SnT were retrospectively reviewed between January 2010 and June 2013. All patients underwent EVAR under general anesthesia. Bilateral femoral arterial access was obtained through bilateral femoral cut-down to place the stent graft mainbody, and brachial arterial access was obtained percutaneously to perform the EnT and/or SnT.


RESULTS
Three patients were treated with unilateral EnT, 1 with unilateral SnT, two with bilateral SnT, and two with combined EnT/SnT. A total of 12 renal arteries was attempted to preserve, and could be successfully performed by these techniques in 11 renal arteries. After complete deployment of the endograft, intraoperative angiography showed no type Ia EL. During the median follow-up of 11 months (range: 2-22 months), no deaths nor aneurysm enlargement occurred, and all treated renal arteries were patent without further intervention.


CONCLUSIONS
Our findings suggest that the management of AAAs by EVAR with EnT and/or SnT could achieve an adequate proximal seal, and preserve renal artery perfusion in patients with unfavorable neck anatomy.
Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Kimihiro
K
Igari
Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Toshifumi
T
Kudo
Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Hidetoshi
H
Uchiyama
Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Takahiro
T
Toyofuku
Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Yoshinori
Y
Inoue
endovascular aneurysm repair; endowedge technique; juxtarenal aortic aneurysm; snorkel technique