Endovascular Management of Suprarenal Aortic Pseudoaneurysm. Are Custom – Made Devices and Chimps Tecniques Safe and Effective Options for These Complex Lesions?

Introduction: Non-traumatic pseudoaneurysm of suprarenal aorta is an infrequent disease; however, it represents for vascular surgeon a challenging lesion. Open surgery for decades was the only treatment option, but at the moment endovascular therapy may be considered as an alternative in high risk patientsMethods: We describe three different endovascular op- tions in three patients who was reffered to our Institution in the last year. In the first case, a custom-made fenes- trated 2-hole tube endograft was implanted for a para- renal pseudoaneurysm. It seemed to be a plaque rupture in the posterior wall of the aorta, just in the room between the two renal arteries in an asymptomatic patient. The remaining part of the aorta was quite normal and a tube graft was planned. In the second case, a customized fenestrated 3-hole bifurcated endograft was implanted for a right aorto-renal pseudoaneurysm. The patient had undergone one month before a coil embolization of the aneurysm and right renal covered stent in urgent setting. After the urgent treat- ment the patient was discharged asymptomatic and a custom-made endograft was planned. At the moment of the second intervention the pseudoaneurysm was enlarged and it was impossible to cannulate the renal stent. The procedure was completed with a plug in the right renal fenestration. In the third case, a symptomatic post-pancreatitis supra-renal aortic pseudoaneurysm was treated with Chimney/Periscope/Snorkel (CHIMPS) tecnique. An Aorto-uni-iliac (AUI) endograft with two Chimney grafts for visceral trunks and two periscope grafts for renal ar- teries was implanted. The AUI choice was necessary for the conic profile from suprarenal to infrarenal segment of the aorta. Results: Technical success was obtained in all cases with a complete exclusion of pseudoaneurismal sac, patency of visceral arteries and absence of endoleaks at completion angiography. Clinical success was obtained in 2 of 3 cases, because the patient with aorto-renal lesion died in the postoperative period for multiple organ failure. A 6-month CT scan confirmed complete exclusion of pseudoaneurysm in absence of any complications in the remaining two patients. Conclusion: The endovascular treatment of complex aortic pseudoaneurysm may be effective, with a high technical success rate even in urgency situations. Although early re- sults are promising, more cases and long-term results are required to understand the safety and effectiveness in long term follow-up