Complications of fenestrated EVAR

1. XXVIII World Congress of the IUA
14th Chinese Capital Vascular Symposium (CCVS)
第28届国际血管联盟世界大会
暨第十四届中国首都血管学术论坛
Host: International Union of Angiology
Organizer: Xuanwu Hospital Capital Medical University
主办: 国际血管联盟
承办: 首都医科大学宣武医院
Complications of A Fenestrated Endovascular Aortic Aneurysm
Repair (EVAR): A Case Study and First Experience of National
Institute of Cardiovascular Diseases Hospital, Dhaka
DR. MOHAMMAD MOYNUL ISLAM
Registrar, Dept of Vascular Surgery
National Institute of Cardiovascular Diseases Hospital (NICVD)
Dhaka, Bangladesh
E-Mail: moyn97@yahoo.com
Contact: +8801726390640

2. Involvesjuxtarenalaortaorsuprarenalaorta

5. Case Summary

6. Pararenal aortic aneurysm

7. CT Angio Findings

8. EVAR Procedure

11. Fenestrated endograft with renal covered stent

12. Endografting with covered stent in both renal arteries

14. On table fenestration by Cautery

15. On table fenestration of endograft boardered by flexible end of .O14” coronary wire

16. Common femoral artery exposure

17. Deployment of main body of aortic endograft

18. Deployment of main body of aortic endograft

19. Deployment of main body of aortic endograft

20. Deployment of main body of aortic endograft

21. Cannulation of renal arteries by percutaneous brachial approach
(7Fr. X 110cm, Ansel sheath)

22. Cannulation of left renal & superior mesenteric artery by percutaneous brachial
approach (7Fr. X 110cm, Ansel sheath)

23. Cannulation of renal arteries by percutaneous brachial approach
(7Fr. X 110cm, Ansel sheath)

24. Deployment of contralateral gate of endograft

25. Deployment of renal and superior mesenteric covered stent

27. Migration of left renal covered stent
Failure to reposition of left renal covered stent

28. Failure to reposition of left renal covered stent
Left renal stent snaring

29. Migration of left renal stent in left internal iliac
artery
Deployment of another left renal covered
stent

30. Deployment of another left renal covered stent

31. Deployment of contralateral (left) iliac extension
accidentally through right iliac limb

32. Deployment of contra-lateral (left) iliac
extension accidentally through right iliac limb

34. Crossover femo-femoral bypass using PTFE
graft done at night

35. Follow Up
• 04/01/2018
– BP=120/70 mm Hg
– Pulse 82/m(R)
– P/A- transmitted pulsation present with bruit
USG of Abdomen
– Endograft in situ
– No endoleak
– Thrombosed sac seen around endograft
CTA
- Endograft in situ
- No endoleak

37. Our Experience

38. Take Home Message
Newer technologies are coming day by day.
So multidisciplinary approach should be needed.

39. THANK YOU
ALL

40. Special Thanks
Fenestrated EVAR was done in NICVD
under supervision of
Dr. Gireesh Mukund Warawdekar
Interventional Radiologist Mumbai, India