# Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique)

## TL;DR

A new endovascular technique called 'Neoneck' is described to treat abdominal aortic aneurysms with challenging aortic neck angles, showing promising early results.

## Contribution

The novel 'Neoneck' technique uses a Palmaz stent to rectify aortic neck angles before endoprosthesis placement in complex AAA cases.

## Key findings

- All patients had immediate technical success with no migration, fracture, or type Ia endoleaks.
- Aneurysmal sac reduction was observed after six months in treated patients.
- The technique was feasible and effective in cases where open repair or ideal devices were not available.

## Abstract

The Endovascular Repair (EVAR) is the first-choice technique for Abdominal Aortic Aneurysm (AAA). Treatment success is dependent on favorable anatomy and an adequate sealing zone formed by a straight aortic neck (slightly angled). Endoprostheses implanted at critical aortic angles (above 75º) may result in unfavorable results such as fracture, migration, and type Ia endoleak. The technique for creating a proximal “Neoneck” consists of implanting the Palmaz stent in the proximal neck of the AAA, before placement of the endoprosthesis, allowing remodeling and rectification of the aortic neck.

To describe the “Neoneck” technique and report the early results of three cases with rectification of the proximal neck angle using a Palmaz stent, enabling treatment in these cases with angulated necks.

We analyzed data collected from patients in whom Palmaz stents were placed, constructing a proximal Neoneck, during EVAR for infrarenal AAA with very tortuous proximal aortic neck, assessing anatomy, devices and perioperative results, including success rates, complications, mortality, and patency in the short and medium term.

All patients presented satisfactory evolution with immediate technical success. There were no cases of migration, fracture, or type Ia endoleaks. There was evidence of aneurysmal sac reduction after six months. There were no complications related to surgical access or deaths.

In cases of angled aortic necks, when open AAA repair is not possible, in the absence of ideal devices or in urgent cases, prior rectification of the aortic neck deploying the Palmaz stent is feasible and effective. Long-term studies are still needed to validate the technique and assess safety.