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Percutaneous Endovascular Treatment of Abdominal Aortic Aneurysm (AAA) Using Endurant AAA Stent Graft
- Operator: Seung-Whan Lee, MD
Case Presentation
An 80-year-old man visited local hospital for a workup of gastrointestinal tract 2 years ago. An AAA (abdominal aortic aneurysm) was detected incidentally by abdominal ultrasonography. He was transferred for the further evaluation of AAA. Computed tomography (CT) showed an AAA having a maximal diameter of 54mm. He had a regular follow up for 2 years. His last CT showed an increased diameter of an AAA (60mm). He had hypertension and dyslipidemia.
Baseline Computed Tomography of the Abdominal Aorta
CT showed a fusiform abdominal aneurysm with mural thrombi from infrarenal level to lower end of abdominal aorta (Figure 1, Figure 2).
Procedure
Both femoral arteries were punctured with 6 Fr sheaths, and then two 8 Fr Proglide devices were placed into each of two femoral puncture sites. With a 6 Fr pigtail catheter, aortography was done via left femoral artery ( Movie 1). A 0.035 inch Lunderquist stiff wire was inserted via right femoral artery and a 20 Fr sheath was placed. An Endurant 20Fr bifurcated stent graft system (28mm [proximal diameter] x 16mm [distal diameter]/120mm in length) was deployed via right femoral sheath ( Movie 2, Movie 3). And then, a 0.035 inch Lunderquist stiff wire was inserted via left femoral artery and a 14 Fr sheath was placed. An Endurant 14Fr contralateral limb stent graft system (16x16mm/120mm) was deployed at left common iliac artery ( Movie 4). The balloon dilatation was done with a Reliant 10-46mm balloon at stent body and both bifurcated branches (Figure 3, Figure 4, Figure 5). Follow-up angiogram showed type I endoleak at proximal attachment, and we considered that right distal fixation length could not be enough ( Movie 5). So additional balloon dilatation was done at proximal attachment and an Endurant 14Fr contralateral limb stent graft system (16x16mm/80mm) was deployed at right common iliac artery ( Movie 6) and several balloon dilatations were done. After that, final angiogram showed successful exclusion of AAA with trivial endoleak at proximal attachment ( Movie 7). After the intervention, both puncture sites were sutured by two prepared Proglides at each site.
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