Thoracic endograft for abdominal aortic aneurysms, an unusual application for severe neck angulation: Case report and literature review

Purpose: To achieve complete proximal sealing in an abdominal aortic aneurysm (AAA) with severe neck angulation (SNA) during endovascular treatment (EVAR) of a patient considered unfit for surgery.Basic methods: An 82 year-old patient with an infra-renal AAA of 9.8cm with SNA of 90° was admitted for acute coronary syndrome. Following coronary treatment, the patient was considered unfit for surgery, and therefore evaluated for EVAR. Aneurysm sac exclusion was obtained with a the deployment of a Powerlink bifurcated graft (Endologix Inc, Irvine, California) inside a Relay thoracic endograft (Bolton Medical, Florida, USA) placed just below the most distal renal artery.Principal findings: At 6 months, angio-CT confirmed correct graft placement, complete aneurysm exclusion and a reduction of the aneurysmal sac.Conclusion: In AAA patients with SNA at high risk of EVAR failure, the adaptability of a thoracic endograft could be considered for proximal sealing.