Korean Circ J.  2016 Sep;46(5):727-729. 10.4070/kcj.2016.46.5.727.

Thrombotic Occlusion of Stent Graft Limbs due to Severe Angulation of Aortic Neck in Endovascular Repair of Abdominal Aortic Aneurysm

• Kim M
• Kim MG
• Kang WC
• Oh PC
• Lee JY
• Kang JM
• Chung WJ
• Shin EK

• KMID: 2389632
• DOI: http://doi.org/10.4070/kcj.2016.46.5.727

Abstract

Endovascular aneurysm repair (EVAR) is a safe alternative to open surgical repair for an abdominal aortic aneurysm. However, unfavorable aortic anatomy of the aneurysm has restricted the widespread use of EVAR. Anatomic limitation is most often related to characteristics of the proximal neck anatomy. In this report, we described a patient with a severely angulated proximal neck who underwent EVAR, but required repeat intervention because of thrombotic occlusion of stent graft limbs.

Keyword

Abdominal aortic aneurysm; Endovascular aneurysm repair; Graft occlusion

MeSH Terms

Aneurysm
Aortic Aneurysm, Abdominal*
Blood Vessel Prosthesis*
Extremities*
Humans
Neck*
Stents*

Figure

• 

  Fig. 1 CT angiography of severely angulated aorta. (A) CT angiography showed fusiform dilatation of aorta with a severely angulated long proximal neck. (B) After EVAR, a follow-up CT angiography demonstrated good patency of stent grafts without graft limb occlusion. Each limb graft, however, was located at the level of a severely angulated aortic neck (white arrow and diagram). (C-E) Seven months after the procedure, a CT angiography revealed kinking and inward compression of the right stent graft limb (arrowhead) with thrombotic occlusion of the right CIA. On contrary, the left stent graft limb was patent without any sign of kinking. However, distal embolization of thrombus was noted at the left EIA and CFA. (F) Emergent embolectomy and femorofemoral bypass were performed. A follow-up CT angiography showed good patency of the femorofemoral bypass graft. CT: computed tomograthy, EVAR: Endovascular aneurysm repair, CIA: common iliac artery, EIA: external iliac artery, CFA: common femoral artery.

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