title: A Combination of Thoracic and Abdominal Stent-Grafts to Treat An Abdominal Aortic Aneurysm with Hostile Proximal Neck.
abstract: Endovascular aneurysm repair (EVAR) actually represents the treatment of choice for most patients affected by abdominal aortic aneurysm (AAA). However, the feasibility of EVAR depends on anatomical characteristics of abdominal aorta and iliofemoral axis. We present the case of an 82-year-old man affected by severe left hydronephrosis, kidney tumor, and ureteral tumor requiring nephrectomy, who also presented a very voluminous AAA with a large diameter (96 mm), and a large proximal neck (39 mm) with severe angulation of the proximal neck (>60°). The patient was considered unfit for traditional EVAR and open surgery. Possible alternatives such as fenestrated endovascular abdominal aortic aneurysm repair and chimney technique were excluded; therefore he was treated combining Valiant Captivia endoprosthesis with the AFX unibody, with a good final result. However, this particular alternative adopted for hostile proximal neck needs long-term follow-up.
authors.affiliation: Vascular Surgery Unit, SS Annunziata Hospital, Taranto, Italy.
authors.forename: Mafalda
authors.initials: M
authors.lastname: Massara
authors.affiliation: Vascular Surgery Unit, SS Annunziata Hospital, Taranto, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Prunella
authors.affiliation: Vascular Surgery Unit, SS Annunziata Hospital, Taranto, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Gerardi
authors.affiliation: Vascular Surgery Unit, University of Messina, Messina, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Caridi
authors.affiliation: Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy. Electronic address: rserra@unicz.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Serra
authors.affiliation: Vascular Surgery Unit, SS Annunziata Hospital, Taranto, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Notarstefano
authors.affiliation: Vascular Surgery Unit, SS Annunziata Hospital, Taranto, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Impedovo
mesh_terms: 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*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome