CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S28
DOI: 10.1055/s-0041-1730723

Stenting Angulated Aortic Aneurysm Neck Before Endovascular Aortic Repair: A Case Report

Mohamed Omar Elfarok
General Organization of Teaching Hospitals and Institutes, Cairo, Egypt
Karim Abdeltawab
General Organization of Teaching Hospitals and Institutes, Cairo, Egypt
› Author Affiliations

Background: Increasing number of patients with angulated abdominal aortic aneurysm (AAA) neck are being treated with endovascular aneurysm repair (EVAR). Moreover, more patients with unsuitable or high-risk anatomy defined in the instructions for use for endografts are being referred to centers with high volume. In this case report, we discuss specific problems that can be encountered during preoperative planning in relation to periprocedural stent graft deployment in patients with angulated AAA necks and offer potential solutions for these problems. The aorta can angulate in several directions (dimensions) simultaneously. Two neck angles are evaluated in the preoperative evaluation. Suprarenal neck angulation refers to an angle measured between the long axis of the immediate suprarenal aorta and the infrarenal aorta. The second angle is aortic neck angulation which measured between the long axis of the infrarenal neck and the long axis of the AAA. Case Report: An 81-year-old male presented to his general practitioner with chronic lower back pain., and pulsatile abdominal mass, patient referred to vascular clinic and a diagnosis of AAA was made, risk factors include diabetes, hypertension and dysliaedemia, CT scan was done which showed 65 mm AAA infrarenal by 15 mm with a severely angled aortic neck. The alpha angle was 89° and the Betal angle was 90°. We planned to deploy self expandable nitinol aortic stent E-XL at the angled neck before the Device to remodel the proximal aorta and then to deploy the device from bilateral femoral cutdowns. We have found that both angles have decreased by 15%, patient was discharged 3 days later with no endoleak. Conclusion: The use of self-expandable E-XL stent in severely angulated necks before EVAR may offer an advantage in lowering the aortic angle to around 15% less and decrease the secondary interventions in these cases.

Publication History

Article published online:
11 May 2021

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