title: Custom-Made Conical Endograft in the Treatment of Saccular Abdominal Aortic Aneurysms with Tight and Calcified Distal Neck: Thinking Out of the Box.
abstract: BACKGROUND
  To describe the use of the combination of a conical custom-made TREO®(TREO CM) stent graft in the treatment of a saccular abdominal aortic endograft (AAA) with long but tight and calcified distal neck.
  
  
  METHODS
  A 65-year-female patient was treated for a saccular 5.2 cm AAA with a 3-cm long but calcified and tight (16 mm) distal neck, precluding the safe use of a bifurcated endograft. Because the patient refused an open surgery, a conical TREO CM endograft was manufactured with 20% proximal oversizing, whereas the 3-cm caudal sealing segment demonstrated a conical configuration comprising a 2-cm and 1-cm nitinol-supported zones of 20% and 10% oversizing, respectively, to avoid excessive strain and incomplete expand at the most distal calcified area, leading ultimately to an insidious infolding and consequent type Ib endoleak. A 24 × 40 mm Treovance aortic cuff was centrally deployed resulting in a 30 mm overlap with the main endograft.
  
  
  RESULTS
  After 6 months, there was complete sealing, and the AAA sac has been shrunk to 45 mm.
  
  
  CONCLUSIONS
  The use of a conical TREO CM endograft with a proximal cuff provides a firm fixation centrally and a sufficient distal sealing design in AAAs with calcified and tight distal aorta, constituting a reliable alternative to bifurcated endografts or aortouniliac configurations followed by crossover adjuncts.
authors.affiliation: Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. Electronic address: efstratiosgeorg@gmail.com.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Georgakarakos
authors.affiliation: Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Argyriou
authors.affiliation: Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Schoretsanitis
authors.affiliation: Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Georgiadis
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; 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*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*