Abstract
Two abdominal aortic aneurysm (AAA) patients with severe neck angulation (SNA) were successfully repaired with Endurant stentgraft systems, which were recently introduced in Japan. Case 1 was an 85-year-old woman with 54 mm maximum AAA diameter. The proximal neck angle was 135 degree and length was 20 mm. Both external iliac artery diameters were 6.1 mm. A stiff guide wire was inserted into the aortic root and the angulated neck became straight. The delivery system of the main stent body could be inserted easily, probably owing to the hydrophilic-coated delivery system and its lower outer diameter (18 F). Thereafter the stiff guide wire was pushed in with a fulcrum at the aortic valve, resulted in the bowing of the stiff guide wire and the delivery system becoming parallel to the proximal neck (device modification technique). Main body could be deployed accurately and smoothly because of the controlled release system of Endurant. Contralateral leg cannulation was easy because the direction of the main body was set as cross leg position. Case 2 was an 84-year-old woman with 52 mm maximum AAA diameter. The proximal neck length was 18 mm. Neck angulation was 130 degree and there was 155 degree angulation distal to the proximal neck. The angulated neck and the distal aortic angulation became straight with stiff guide wire insertion (aortic modification technique). During the deployment of the main part of the bifurcated stent graft, we waited until the main part fitted spontaneously to the proximal neck by pulsatile aortic blood pressure. As in case 1, the insertion of the 18 F delivery system of main body was easy although the external iliac artery diameter was only 6.0 mm. In both cases, there was no type I nor III endoleak by postoperative contrast enhanced CT. More AAA patients with challenging anatomy might be repaired with Endurant, because Endurant has greater flexibility due to the wire-formed M-shaped stents, controlled release system of endografts and suprarenal stents for accurate and smooth delivery, suprarenal active fixation by supra renal stent and anchoring hooks, and hydrophilic coated system with lower outer diameter.
