CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
e4
AFRICA
Case Report
Endovascular stent-graft repair for abdominal aortic
aneurysm in a patient with a short and severely
angulated proximal aortic neck
AE-YOUNG HER, YONG HOON KIM
Abstract
Serious anatomical limitations to endovascular aortic aneu-
rysm repair (EVAR) are mostly related to the anatomical
characteristics of the proximal neck of the aneurysm. A
75-year-old male was referred for management of an inci-
dentally found large asymptomatic infra-renal saccular
abdominal aortic aneurysm. Its proximal aortic neck was
short and severely angulated. We performed successful
EVAR in this patient without surgical intervention.
Keywords:
aortic aneurysm, stent-graft, aneurysm morphology
Submitted 11/5/13, accepted 18/6/13
Cardiovasc J Afr
2013;
24
: e4–e7
DOI: 10.5830/CVJA-2013-048
In 1991 Parodi first reported the technique of trans-femoral
catheter-based repair of an infra-renal abdominal aortic
aneurysm (AAA) as an alternative to the management of patients
whose medical co-morbidities made them poor candidates
for conventional surgical treatment.
1
Currently, endovascular
repair of AAA is known to be less invasive, reduce the need for
hospitalisation, and decrease morbidity and mortality rates than
standard open repair.
2
However, serious anatomical limitations to endovascular
aortic aneurysm repair (EVAR) remain, mostly related to
anatomical characteristics of the proximal neck of the aneurysm.
3
We report on a successful EVAR without surgical intervention in
a patient with a large, asymptomatic infra-renal saccular AAA.
Its proximal aortic neck was short and severely angulated.
Case report
A 75-year-old male was referred for the management of an
incidentally found large asymptomatic infra-renal saccular
AAA. His risk factors for coronary artery disease were age and
hypertension. Approximately eight years previously, the patient
had had a lumbar spine operation due to intervertebral disc
herniation. Two weeks previously, he had visited the orthopaedic
clinic for more surgery. During the pre-operative MRI work
up of the lumbar spine, they had incidentally found a large
abdominal aortic aneurysm. He was referred to our hospital.
The patient underwent a contrast-enhanced CT angiogram
of the abdominal aorta. Three-dimensional reconstruction was
performed (Fig. 1). The image studies revealed that the aneurysm
was large, saccular (6.0
×
7.8 cm) and there were mural thrombi
within the abdominal aorta but not in the aneurismal neck. It was
Division of Cardiology, Department of Internal Medicine,
Kangwon National University School of Medicine,
Chuncheon, Korea
AE-YOUNG HER, MD, PhD
YONG HOON KIM, MD, PhD,
Fig. 1. Three-dimensional reconstructed CT angiogram
showing a large infra-renal saccular abdominal aortic
aneurysm and aneurysm dilatation of both iliac arteries
and the ascending aorta.
