Publicação
Overcoming hostile neck anatomy in endovascular abdominal aortic aneurysm repair using the reverse slider technique - a case report
| Resumo: | Abstract Background: Around 40% to 60% of patients with abdominal aortic aneurysm (AAA) are deemed outside the instructions for use for endovascular aneurysm repair (EVAR) because of hostile anatomy. Short and angulated necks pose a serious risk of type Ia endoleak due to difficulty achieving adequate proximal fixation and endograft seal. Report: A 72-year-old male with a history of dyslipidaemia and smoking was admitted to the vascular ward with a diagnosis of an AAA measuring 85 mm in diameter. The patient had recently undergone a Hartmann procedure for transmural ischemic colitis. Despite suboptimal anatomy for EVAR, including a short proximal neck (13 mm) and severe infrarenal angulation (90°), endovascular repair with the Endurant II stent graft was performed, using the reverse slider technique. The procedure was technically successful, with angiography confirming proper graft fixation and aneurysm exclusion. Follow-up computed tomography angiography at one month demonstrated correct endograft positioning with no evidence of endoleak. Conclusion: The reverse slider technique allows proximal sealing in short and angulated neck aneurysms. It involves repeatedly rotating the external slider in the reverse direction while gradually deploying the suprarenal stent, allowing the proximal edge of the endograft to expand and progressively approach the contralateral aortic wall. |
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| Autores principais: | Rocha,Ana Margarida |
| Outros Autores: | Coelho,Andreia; Fernandes,Luís; Canedo,Alexandra |
| Assunto: | Abdominal aortic aneurysm short neck angulated neck reverse slider technique |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | relatório |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Fundação para a Ciência e Tecnologia |
| Idioma: | inglês |
| Origem: | SciELO Portugal |
| Resumo: | Abstract Background: Around 40% to 60% of patients with abdominal aortic aneurysm (AAA) are deemed outside the instructions for use for endovascular aneurysm repair (EVAR) because of hostile anatomy. Short and angulated necks pose a serious risk of type Ia endoleak due to difficulty achieving adequate proximal fixation and endograft seal. Report: A 72-year-old male with a history of dyslipidaemia and smoking was admitted to the vascular ward with a diagnosis of an AAA measuring 85 mm in diameter. The patient had recently undergone a Hartmann procedure for transmural ischemic colitis. Despite suboptimal anatomy for EVAR, including a short proximal neck (13 mm) and severe infrarenal angulation (90°), endovascular repair with the Endurant II stent graft was performed, using the reverse slider technique. The procedure was technically successful, with angiography confirming proper graft fixation and aneurysm exclusion. Follow-up computed tomography angiography at one month demonstrated correct endograft positioning with no evidence of endoleak. Conclusion: The reverse slider technique allows proximal sealing in short and angulated neck aneurysms. It involves repeatedly rotating the external slider in the reverse direction while gradually deploying the suprarenal stent, allowing the proximal edge of the endograft to expand and progressively approach the contralateral aortic wall. |
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