Use of Combined Thoracic and Abdominal Endografts for Proximal Severe Neck Angulation in Abdominal Aortic Aneurysms

PurposeTo evaluate endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) with severe neck angulation (SNA) utilizing a thoracic endograft placed proximal to a bifurcated endograft.MethodsA retrospective review was conducted of 28 consecutive EVAR patients (25 men; mean age 71 years, range 62–86) with proximal SNA ≥60° treated electively between December 2006 and May 2011. The average AAA neck diameter was 23 mm (range 22–28), with a mean length of 25 mm (range 10–51) and a mean maximum sac diameter of 63 mm (range 55–98). The mean neck angulation was 73° (range 60–92). All patients received an endograft designed for the thoracic aorta (Relay) placed as a proximal extension above a bifurcated abdominal aortic endograft (IntuiTrak Powerlink).ResultsTechnical success was achieved in 100% of cases. An intraoperative type I proximal endoleak was successfully treated with stent deployment, and 2 type II endoleaks spontaneously resolved within 30 days. In all 28 patients, endograft integrity an...