Neck Remodeling Using the Amplatzer Vascular Plug to Facilitate Endovascular Repair of a Contained Abdominal Aortic Rupture

Abstract

Purpose

To describe the use of an Amplatzer Vascular Plug to facilitate endovascular aneurysm repair (EVAR) in a renal transplantation recipient with contained rupture of an abdominal aortic aneurysm (AAA).

Case Report

A 52-year-old man with a history of kidney transplantation and a 4-cm AAA was referred to our hospital with severe abdominal pain. Imaging showed the contained AAA rupture measuring 8 cm, with 2 blisters at the proximal short neck and narrow calcified iliac arteries. The blisters were the probable sites of rupture, and the cranial one was 4 mm below the superior mesenteric artery, precluding conventional EVAR. The Amplatzer Vascular Plug was used to occlude the blister and remodel the proximal neck so that a low-profile Ovation prosthesis could be passed through the narrow calcified iliac artery without damaging the transplanted renal artery anastomosed to the external iliac artery.

Conclusion

The unconventional use of the Amplatzer Vascular Plug for neck remodeling made EVAR possible in this case.