Overcoming Anatomical Constraints: A Case of Successful Endovascular Repair in a High-Risk Patient With a Short, Angulated Abdominal Aortic Aneurysm

TL;DR

A high-risk patient with a short, angulated abdominal aortic aneurysm successfully underwent endovascular repair using a specialized technique.

Contribution

Demonstrates successful EVAR in a challenging anatomical case using the chimney technique, challenging traditional contraindications.

Findings

The patient had no complications and stable renal function one month post-procedure.

Routine CT scans showed no endoleaks or other complications.

The chimney technique allowed EVAR success in a traditionally unsuitable case.

Abstract

Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is often limited by anatomical factors such as short necks (less than 15 mm) and significant angulation (over 60 degrees), making EVAR unsuitable. We present a case of a 60-year-old man with multiple comorbidities and a short, markedly angulated AAA neck. Despite being deemed unsuitable for EVAR, the patient underwent successful EVAR with the chimney technique. At the one-month follow-up, the patient had no complications, stable renal function, and no detected endoleak or other complications on routine CT scans. Cardiac tests were normal. This case challenges traditional contraindications and highlights the potential for EVAR in challenging anatomical situations. Incorporating the chimney technique and reinforcing the proximal neck can prevent complications, while future research should focus on tailored EVAR strategies addressing individual needs and anatomical challenges.

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