First case of relining an aortic bifurcated bypass graft with the Altura endograft to treat anastomotic aneurysms

Abstract

Objective Use of classic bifurcated endografts for relining of bifurcated aortic bypass grafts with aneurysms is usually precluded by the short distance between the lowermost renal artery and the aneurysmatic bifurcation, rendering their management challenging. Methods We present the use of the Altura endograft in a case of a 75-year old male with large anastomotic aneurysms in the proximal and the left iliac amastomosis of a bifurcated aortic bypass graft. The Altura endograft consists of two separate components with a proximal D-shaped design. Its braided nitinol endoskeleton is attached only at the proximal and distal ends of the inner surface of the polyester fabric and results in adjustable lengths of the components according to the vessel diameters where they are deployed. Results A 24 mm Altura sealed successfully at the native infarenal aortic segment covering the entire distance between the lowermost renal artery and the upper end of external iliac artery, providing successful exclusion of the aneurysms. No iliac extensions were used. The completion angiography showed no endoleaks. Conclusions The unique design of Altura makes it ideal for treatment of anastomotic aneurysms of bifurcated bypass grafts, overcoming anatomic limitations. To the best of our knowledge, this is the first report addressing this crucial issue.