Endovascular treatment of large and wide aortic neck: case report and literature review

• Published in: General thoracic and cardiovascular surgery Vol. 65; no. 4; pp. 219 - 224
• Main Authors: Pecoraro, Felice, Pakeliani, David, Dinoto, Ettore, Bajardi, Guido
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.04.2017; Springer Nature B.V
• Subjects: Abdomen; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Blood Vessel Prosthesis Implantation - methods; Cardiac Surgery; Cardiology; Case Report; Case reports; Coronary vessels; Endovascular Procedures - methods; Humans; Literature reviews; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neck; Patients; Stents; Surgical Oncology; Thoracic Surgery; Time Factors; Tomography; Tomography, X-Ray Computed; Veins & arteries; Germany; Funnel technique; Complications; Endoleak; Migration; Large neck
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-016-0627-2

Large (24–34 mm) and wide (≥35 mm) aortic necks are a contraindication to endovascular aneurysm repair (EVAR). A 63-year-old man, unfit for conventional surgery, presented a 79 mm abdominal aortic aneurysm with 36.5 mm aortic neck and a 62 mm right common iliac artery aneurysm. He was treated endovascularly with standard commercially available stent-graft using the so-called ‘funnel technique’; by placing a thoracic stent-graft inside a bifurcated device to achieve proximal sealing. The completion angiography and the 6 months follow-up with computed tomography showed no stent-graft migration, limb occlusion or endoleak. The literature review reported 179 cases of large aortic neck managed with EVAR, all cases treated with standard devices. Conversely a wide aortic neck was reported in 9; in 2 cases were employed custom-made devices and in 7 standard stent-graft. The use of EVAR with commercially available stent-grafts is feasible and it represents an option especially in non-elective setting.