Question

What are the endovascular options for less than adequate neck length for an infrarenal abdominal aortic aneurysm?

Hint:

In patients with short aortic necks, fenestrated and branched endografts offer a viable solution to secure a proper fit and reduce the risk of complications.

Answer 1

Step 1: Introduction:
In some patients with infrarenal abdominal aortic aneurysms (AAA), the aortic neck (the area where the graft attaches) may be too short or inadequately shaped for standard endovascular graft deployment. In these cases, special techniques and grafts are needed to ensure the procedure’s success.
Step 2: Endovascular Options:
1. Bilateral Iliac Artery Grafts: These can be used when the aortic neck is too short to secure a standard graft, allowing for better anchoring to the iliac arteries. 2. Chimney or Sandwich Technique: Involves placing a stent graft in the aorta and a secondary stent graft in the renal or iliac arteries to secure the graft and provide adequate flow. 3. Fenestrated Grafts: These grafts have holes (fenestrations) that allow the graft to be deployed around branch vessels such as the renal arteries, improving fit and stability in patients with short necks. 4. Endograft with Extension Sleeves: Extension sleeves can be used to provide additional support and length to the aortic neck, making the graft more stable.
Step 3: Considerations:
Choosing the right approach depends on the patient’s anatomy, and a careful preoperative assessment using imaging techniques like CT angiography is critical to planning the appropriate procedure.