Prevention of Kinked Stent Graft Limb Due to Severe Angulated Proximal Neck during Endovascular Repair for Abdominal Aortic Aneurysm

Abstract

Although the technology of endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is evolving that make it appealing for challenging anatomy, proximal aortic neck morphology, especially severe angulation, is still one of the most determinants for a successful procedure. We describe a patient of AAA with severely angulated proximal neck, in whom kinked stent graft limb occurred against severe angulation of proximal neck. Then, we suggested how to prevent this complication in the second patient. Our case demonstrated the stent graft limb could be kinked by severe aortic neck angulation, making it challenging. However, the kinked stent graft limb could be prevented by deploying stent graft limbs below the most severely angulated aortic neck intentionally.

Acute occlusion of aortic endovascular aneurysm repair stent graft with bilateral limb ischemia

“…A severely tortuous and angulated aorta and iliac arteries can cause the stent graft to improperly adhere to the vessel walls. However, Oh et al 8 demonstrated that deploying stent graft limbs extensively above or below severely angulated vessels could prevent kinking of the stent graft.…”

CT angiography for the assessment of EVAR complications: a pictorial review

“…Device kinking may occur in 2–4% of patients, due to size reduction in the residual aneurysm sac over time, severe proximal aortic neck angulation and a narrow diameter of the distal aortic neck [ 3 , 49 , 50 ]. Device kinking (Fig.…”

“…Device kinking (Fig. 14 ) can be localized at stent-graft limb and is defined as a sharp localized angulation > 90° on radiological examination [ 50 , 51 ]. Kinking can lead to device migration, type I and type III EL , endograft thrombosis and occlusion [ 49 ].…”