Endovascular repair with chimney technique of abdominal aortic aneurysm with hostile aortic neck

Abstract

Abdominal aortic aneurysm (AAA) with hostile aortic neck is not a good candidate for conventional endovascular aneurysm repair (EVAR), and a recent paper showed that EVAR with chimney technique (Ch-EVAR) yielded reasonable outcome. We report here a case of successful Ch-EVAR treatment of AAA with hostile neck. An 81-year-old man presented with a 71-mm AAA during evaluation of a gastric ulcer. Aortic neck was 30 mm in diameter, 10–15 mm in length and angulated by 100°. EVAR was performed with chimney stenting to both renal arteries, and the patient recovered after transient hematuria. At one-year follow-up, AAA had increased by 7 mm with delayed type I endoleak control without renal insufficiency. The patient needed close follow-up.

Keywords

aortic aneurysm angioplasty intervention renal artery

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References

Chaikof

Fillinger

Matsumura

Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair. J Vasc Surg 2002;35:1061–6

Waasdorp

de Vries

Hobo

Leurs

Buth

Moll

. Aneurysm diameter and proximal aortic neck diameter influence clinical outcome of endovascular abdominal aortic repair: a 4-year Eurostar experience. Ann Vasc Surg 2005;19:755–61

AbuRahma

Campbell

Mousa

Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J Vasc Surg 2011;54:13–21

Black

Wolfe

Clark

Hamady

Cheshire

Jenkins

. Complex thoracoabdominal aortic aneurysm: endovascular exclusion with visceral revascularization. J Vasc Surg 2006;43:1081–9

Verhoeven

Vourliotakis

Bos

Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: an 8-year single-centre experience. Eur J Vasc Endovasc Surg 2010;39:529–36

Verhoeven

Tielliu

Bos

Zeebregts

. Present and future of branched stent grafts in thoracoabdominal aortic aneurysm repair: a single-centre experience. Eur J Vasc Endovasc Surg 2009;38:155–61

Bruen

Feezor

Daniels

Beck

Lee

. Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysm. J Vasc Surg 2011;53:895–905

Greenberg

Clair

Srivastava

Should patients with challenging anatomy be offered endovascular aneurysm repair?

J Vasc Surg 2003;38:990–6

Hiramoto

Chang

Reilly

Schneider

Rapp

Chuter

. Outcome of renal stenting for renal artery coverage during endovascular aortic aneurysm repair. J Vasc Surg 2009;49:1100–6

10.

Schermerhon

Finlayson

Fillinger

Life expectancy after endovascular versus open abdominal aortic aneurysm repair: results of a decision analysis model on the basis of data from EUROSTAR. J Vasc Surg. 2002;36:1112–20