title: A Word of Caution for Extra Large Self-expandable Nitinol Stents.
abstract: BACKGROUND
  To report an unsuccessful use of large nitinol stent to prevent proximal endoleak in endograft treatment for juxtarenal aortic aneurysm.
  
  
  METHODS
  An 82-year-old male presented coronary disease and severe chronic obstructive pulmonary disease requiring oxygen support. A large 80-mm juxtarenal aneurysm was found on routine urological examination. Neck features were as follows: 7 mm and high anterior-posterior angulation. ASA risk score IV was given. Patient wanted to be treated. We decided a 1-shot intervention based on self-expandable suprarenal fixation endograft with adjunctive extra large self-expandable (high radial force) nitinol stent. Control computed tomography scan demonstrates nitinol stent severe infolding and a possible perforation of the primary endograft. At 6-month follow-up, sac reveals enlargement of 5 mm and 6% volume increase. Patient does not want further treatments due to high risk of procedures.
  
  
  CONCLUSIONS
  Extreme caution should be taken when using self-expandable extra large nitinol stents for preventive matters. Oversizing should be carefully considered, not necessarily reaching the endograft chosen size. When short and angulated neck morphology co-exists, other devices or procedures may be a better option.
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain. Electronic address: cauzaza@hotmail.com.
authors.forename: Andrés
authors.initials: A
authors.lastname: Reyes Valdivia
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain.
authors.forename: Africa
authors.initials: A
authors.lastname: Duque Santos
authors.affiliation: Department of Vascular and Endovascular Surgery, Juan Canalejo's University Hospital, A Coruña, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez Marcos
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Romero Lozano
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Ocaña Guaita
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gandarias Zúñiga
mesh_terms: D000497:Alloys; D017544:Aortic Aneurysm, Abdominal / 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 / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
chemical_list: D000497:Alloys; C013616:nitinol