Endovascular treatment of arterial aneurysms with side-branches – a simple method. Myth or reality?

Endovascular aneurysm repair has evolved into a routine procedure for the treatment of abdominal and thoracic aortic and peripheral aneurysms.1-3 However, the use of endograft devices is limited to patients with aneurysms of suitable anatomy. Numerous devices are on the market, with some first- and second-generation stent-grafts having already been withdrawn due to improvements in the newer generation devices.4 Among others, single-layer bare stents have been used clinically to treat aneurysms, but the porosity must be so low that the device becomes too rigid and inflexible to conform well to the vessel wall.5 If an aneurysm is adjacent to or involving a major arterial branch, a stent-graft would occlude the branch as well.6 If an aneurysm is particularly large, embolization becomes more problematic and expensive if coils are used. How then could one treat a large, wide-necked aneurysm in proximity to or involving a major arterial branch? A new type of multilayer self-expanding stent technology has been developed that may offer an endovascular alternative to surgery in such cases.7 We report herein our initial experience with this novel technology in patients with aneurysms, particularly those involving side-branches.