title: Challenging narrow distal aorta in abdominal aortic aneurysm--endovascular repair using a reversed flared endoprosthesis.
abstract: BACKGROUND
  Narrow aortic bifurcations are a challenging issue while treating abdominal aortic aneurysm by endovascular means. Off-the-shelf products are often not suitable and special considerations and custom-made endoprostheses are necessary.
  
  
  METHODS
  Alternatively, some morphologies qualify for a flared tube graft. We report two successful aneurysm exclusions using custom-made (Anaconda, Vascutek/Terumo) step-down diameter grafts in patients with tight distal aortas without the need for pre-interventional endograft adjustments.
  
  
  CONCLUSIONS
  In these two cases, implantation of a custom-made proximally flared tube endograft in treating a localised abdominal aortic aneurysm with a narrow and calcified bifurcation seems feasible. They represent uncommon, yet challenging, issues worthy of attention.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Kantonsspital Graubuenden, Loestrasse 170, Chur, Switzerland. wyssmd@gmail.com
authors.forename: T R
authors.initials: TR
authors.lastname: Wyss
authors.forename: G
authors.initials: G
authors.lastname: Heller
authors.forename: M
authors.initials: M
authors.lastname: Furrer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000601:surgery