Abstract
INTRODUCTION The standard for aortic aneurysm repair, especially for infrarenal aneurysm, has traditionally been an open surgical approach. The open surgical approach involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients of advanced age and with pulmonary, cardiac, and renal dysfunction. However, the patient’s vascular anatomy remain challenges in EVAR. PRESENTATION OF CASES A 70-year-old man complained of intermittent abdominal pain for three days. Computed tomography angiogram demonstrated a tortuous infrarenal abdominal aortic aneurysm with a 45° of infrarenal angulation and a 45° left iliac artery angle. Aneurysmal dilatation and severe calcification of bilateral common iliac arteries and tortuous left common illiac arteries access were also showed. Since the limitation of equipment from the district hospital to have endovascular repair, the patient was transferred to our hospital for further evaluation and possible EVAR. EVAR was performed successfully using Endurant stent-grafts and and vascular plug. DISCUSSION : EVAR contraindications are derived largely on the basis of the patient’s vascular anatomy. The success of the procedure is dependent on the correct selection of the patient on the basis of vascular anatomy, most important neck morphology. In this patient, before deployment of main body, right internal artery iliac was closed with Amplatzer Vascular Plug (AVP 1) 10 mm, to prevent type 1 endoleak. During the procedure, cannulation of the contralateral limb was unable to be achieved because of the tortuous left common iliac artery course. Therefore, a snare was inserted from left brachial artery, through the contralateral gate, to grasp the wire from left femoral artery. One iliac stent-graft was deployed with the lower end distal to the middle of the right external iliac artery. Angiography confirmed complete sealing of the aneurysm with patency of bilateral renal arteries, right common iliac artery and left internal iliac artery. There were no postoperative complication. CONCLUSION Even endovascular repair of abdominal aortic aneurysm with hostile neck and tortuous access is challenging, appropriate choosing of stent-grafts and suitable techniques is able to achieve a good outcome.
Original language | English |
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Title of host publication | Asian Society for Vascular Surgery 2018, 19th Congress of Asian Society for Vascular Surgery |
Publication status | Published - Jul 2018 |