# Management of a unique hourglass-shaped abdominal aortic aneurysms: A case report

## TL;DR

This case report describes the successful open surgery for a rare hourglass-shaped abdominal aortic aneurysm in a high-risk patient.

## Contribution

The paper presents a unique case of hourglass-shaped AAA managed through open surgery due to unsuitability for endovascular repair.

## Key findings

- Endovascular repair was not feasible due to inadequate proximal landing zones.
- Open surgical intervention was necessary to safely repair the aneurysm.
- Preoperative imaging was critical in guiding the treatment decision.

## Abstract

Hourglass-shaped abdominal aortic aneurysms (AAAs) represent a complex variant of aneurysms, characterized by a distinctive constriction within the aorta, which are characteristically located in the abdominal or thoracic regions. Their unique morphology poses significant diagnostic and therapeutic challenges, particularly when considering the feasibility of endovascular repair versus open surgical intervention, demanding a specific approach to management.

We present the case of a 68-year-old female patient admitted with abdominal pain complaints. Despite stable vital signs, her medical history, including diabetes mellitus and reduced ejection fraction (EF) of 40 %, indicated a heightened cardiovascular risk. Subsequent imaging studies, including Doppler ultrasonography and CT angiography, showed the presence of two adjacent abdominal aortic aneurysms forming an hourglass-shaped configuration. Due to the inadequacy of the proximal landing zone for an endovascular procedure, an open surgical intervention was considered necessary to address the aneurysms.

Managing the hourglass-shaped AAAs requires careful consideration due to their complex morphology, which can complicate the option between endovascular and open surgical repair. While Endovascular Aneurysm Repair (EVAR) is often a preferred method for high-risk patients due to its minimally invasive nature, in this case, insufficient proximal landing zones made the EVAR unsuitable. Open surgery, although more aggressive, was required to prevent complications such as ensuring a safe repair and rupture. Perspective imaging and patient-specific factors played an important role in guiding the treatment plan, highlighting the importance of individual approaches in managing complex vascular discrepancies.

The present article reports the management of a patient with an hourglass-shaped AAA, emphasizing its relevant diagnostic challenges, the rationale behind treatment decisions, and the outcomes we achieved. Our findings highlight the need for personalized approaches in managing complex aneurysmal presentations.

•Hourglass-shaped abdominal aortic aneurysms (AAAs) are rare and pose unique diagnostic and therapeutic challenges.•This case report details the successful open surgical repair of a complex hourglass-shaped AAA in a high-risk patient.•Endovascular aneurysm repair (EVAR) was deemed unsuitable due to insufficient proximal landing zones.•Preoperative imaging played a crucial role in surgical planning and decision-making.•This case emphasizes the need for individualized management strategies for complex vascular anomalies.

Hourglass-shaped abdominal aortic aneurysms (AAAs) are rare and pose unique diagnostic and therapeutic challenges.

This case report details the successful open surgical repair of a complex hourglass-shaped AAA in a high-risk patient.

Endovascular aneurysm repair (EVAR) was deemed unsuitable due to insufficient proximal landing zones.

Preoperative imaging played a crucial role in surgical planning and decision-making.

This case emphasizes the need for individualized management strategies for complex vascular anomalies.