title: Endovascular treatment of complex abdominal aortic aneurysms by combining different types of endoprostheses.
abstract: OBJECTIVE
  To describe an off-the-shelf method for the treatment of abdominal aortic aneurysms with hostile (large, >30 mm) neck and/or small (<20 mm) aortic bifurcation.
  
  
  METHODS
  We describe five patients with large aortic necks and/or small aortic bifurcations, which were treated by combining an AFX endoprosthesis with a Valiant Captiva endograft, and additional proximal endoanchors when deemed necessary. Initial technical success was 100%. Follow-up ranged from 228 to 875 days. One patient suffered a type 1A and 1B endoleak at 446 days follow-up, which were successfully treated by endovascular means.
  
  
  CONCLUSIONS
  Combining the AFX and Valiant Captiva endografts is an off-the-shelf solution for treatment of large diameter aortic necks and small aortic bifurcations in patients deemed unfit for open repair or declined for fenestrated endografts. Longer follow-up is required to assess the long-term safety with special focus on aortic neck dilation.
authors.affiliation: Department Of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands mennodebruijn@gmail.com.
authors.forename: Menno T
authors.initials: MT
authors.lastname: de Bruijn
authors.affiliation: Department Of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Tournoij
authors.affiliation: Department Of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Daniel Af
authors.initials: DA
authors.lastname: van den Heuvel
authors.affiliation: Department Of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Debbie
authors.initials: D
authors.lastname: de Vries-Werson
authors.affiliation: Department Of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Wille
authors.affiliation: Department Of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jean-Paul Pm
authors.initials: JP
authors.lastname: de Vries
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome
keywords: Endovascular aneurysm repair; abdominal aortic aneurysm; aneurysm neck; endoanchor; off-label use; off-the-shelf device