title: Penetrating aortic ulcer in the infrarenal stent-graft landing zone: treatment with coils and the ethylene vinyl alcohol copolymer onyx.
abstract: OBJECTIVE
  To describe a technique to enable endovascular aneurysm repair in patients with penetrating aortic ulcer (PAU) in the infrarenal neck of an abdominal aortic aneurysm (AAA).
  
  
  METHODS
  The technique is illustrated in a 76-year-old man with a 5.7-cm infrarenal AAA and a 2.3 × 1.8-cm PAU situated immediately distal to the right renal artery and covering 20% of the 28-mm-diameter proximal aortic neck. During the stent-graft repair, the PAU was successfully excluded by embolization with coils and the ethylene vinyl alcohol copolymer Onyx. The AAA and PAU were completely excluded without complications. At 6 months, there were no signs of endoleak, the AAA remained excluded, and there was no reperfusion of the Onyx cast in the PAU.
  
  
  CONCLUSIONS
  This technique for treatment of a PAU in the proximal neck of an AAA is a reasonable alternative in cases involving severely diseased infrarenal necks that would otherwise require open surgery. The liquid embolic agent Onyx performed well, with fast embolization and excellent control of the growing cast maintained by the interventionist.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Clinical Centre of the Ludwig Maximilians University of Munich, München,Germany.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Sadeghi-Azandaryani
authors.forename: Hanna
authors.initials: H
authors.lastname: Strube
authors.forename: Jens
authors.initials: J
authors.lastname: Heyn
authors.forename: Bernd
authors.initials: B
authors.lastname: Steckmeier
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Marcus
authors.initials: M
authors.lastname: Treitl
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D008297:Male; D011145:Polyvinyls / Q000627:therapeutic use*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide