case_images: PMC10905129_01
case_images: Endovacular aortic repair with multiple stiff wire technique of the 1
  st patient.. A. Preoperative volume rendering computed tomography angiography (CTA); B. Initial aortography showed 90  angulation of proximal neck; C. Aortography showed reduction of the proximal neck angulation after insertion of the second stiff wire into 69 ; D. Stent graft main body deployment; E. Final aortography; F. Follow up volume rendering CTA after three months.
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case_images: PMC10905129_01_f1000research-12-160558-g0000.jpg
case_images: f1
case_images: Infrarenal neck length is 22 mm with angulation of 90  ( Figure 1A). Initial aortography revealed a fusiform aneurysm at infrarenal abdominal aorta with short and tortuous neck with angulation angle of 90  ( Figure 1B). The proximal neck angulation was reduced into 69  ( Figure 1C). An Endurant II ETBF 23 mm x 13 mm x 145 mm stent graft main body (Medtronic, Santa Rosa, CA, USA) was deployed via right femoral artery (RFA) access ( Figure 1D). Final aortography revealed a good position of the stent grafts, both renal and iliac arteries were filled with contrast, and no sign of endoleak was found ( Figure 1E). The follow-up CTA after 3 months revealed stent expansion of 19.3 mm at infrarenal aorta (maximum diameter was 60.2 mm), good stent position without stent migration and no endoleak was found ( Figure 1F).
case_images: PMC10905129_02
case_images: Endovacular aortic repair with multiple stiff wire technique of the 2
  nd patient.. A. Preoperative volume rendering computed tomography angiography (CTA); B. Initial aortography with two stiff wire showed straightening of the proximal neck angulation into 38.2 ; C. Stent graft main body deployment; D. Final aortography; E. Follow up volume rendering CTA after three months.
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case_images: PMC10905129_02_f1000research-12-160558-g0001.jpg
case_images: f2
case_images: CTA revealed a contained rupture of abdominal aortic aneurysm with intraluminal thrombus with a length of 10.32 cm and maximum sac diameter of 10.1 cm (maximum vascular diameter filled with contrast was 6.49 cm), Infrarenal neck length is 18.9 mm with angulation of 70.2  ( Figure 2A). The MSW technique was applied to this patient and it reduced the proximal neck angulation into 38.2  ( Figure 2B). A SEAL Bifurcated Stent Graft sized 28 x 50 mm (S&G Biotech, Yongin, Korea) main body was deployed via RFA ( Figure 2C). After several post-dilatation was done with Reliant Stent Graft Balloon (Medtronic, Santa Rosa, CA, USA), the right limb extension expanded perfectly ( Figure 2D). Follow-up CTA after three months revealed stent expansion of 33.5 mm at infrarenal aorta (maximum diameter with thrombus was 69 mm), no stent migration, and no endoleak was found ( Figure 2E).
case_images: PMC10905129_03
case_images: Endovacular aortic repair with multiple stiff wire technique of the 3
  rd patient.. A. Preoperative volume rendering computed tomography angiography (CTA); B. Initial aortography with two stiff wire showed straightening of the proximal neck angulation into 63.1 ; C. Stent graft main body deployment; D. Final aortography.
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case_images: PMC10905129_03_f1000research-12-160558-g0002.jpg
case_images: f3
case_images: CTA revealed dissection of abdominal aorta aneurysm with a length of 6.99 cm and maximum sac diameter of 5.95 cm (maximum vascular diameter filled with contrast was 3.89 cm), infrarenal neck length is 5.00 mm with angulation of 75.4  ( Figure 3A). MSW technique reduced the proximal neck angulation into 63.1  ( Figure 3B). SEAL Bifurcated Stent Graft 24 x 50 mm main body (S&G Biotech, Yongin, Korea) was deployed via RFA ( Figure 3C). Evaluation aortography revealed that contras filled the whole cover stent without endoleak ( Figure 3D).
case_images: PMC10905129_04
case_images: Endovacular aortic repair with multiple stiff wire technique of the 4
  th patient.. A. Preoperative volume rendering computed tomography angiography (CTA); B. Initial aortography; C. After stent implantation, arteriography revealed stenosis at left CIA; D. Iliac stent graft deployment; E. Final aortography; F. Follow up volume rendering CTA after three months.
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case_images: PMC10905129_04_f1000research-12-160558-g0003.jpg
case_images: f4
case_images: The access site was tortuous and heavily calcified ( Figure 4A). Initial aortography revealed a fusiform aneurysm at infrarenal abdominal aorta with stenosis at both CIAs ( Figure 4B). Arteriography revealed there was still stenosis at left CIA ( Figure 4C). Figure 4D). Final aortography revealed a good position of the stent-grafts, both renal arteries and iliac arteries were filled with contrast, and no sign of endoleak was found ( Figure 4E). Follow-up CTA after 3 months revealed stent expansion of 23.0 mm at suprarenal aorta, 30.8 mm at infrarenal aorta (maximum diameter with thrombus was 59.1 mm), 28.8 mm at aortic bifurcation, 9.3 mm at right CIA, and 9.9 mm at left CIA, no stent migration, and no endoleak was found ( Figure 4F).
case_images: PMC10905129_05
case_images: Thoracic endovacular aortic repair with multiple stiff wire technique of the 5
  th patient.. A. Preoperative volume rendering computed tomography angiography (CTA); B. Initial aortography with two stiff wires revealed 70.9  angulation of the descending thoracic aorta; C. Additional stiff wire was added and straighten the angulation into 50.7 ; D. Stent graft deployment; E. Final aortography; F. Follow up volume rendering CTA after three months.
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case_images: f5
case_images: CTA revealed an aortic aneurysm with extensive mural thrombus with aorta descendent's maximum diameter of 53.5 mm, thoracoabdominal aorta maximum diameter of 92.5 mm, suprarenal aorta maximum diameter of 98.1 mm, infrarenal aorta maximum diameter of 51.8 mm, with angulation of 70.2 , and suspected rupture at peritoneal and thorax cavity ( Figure 5A). Initial aortography revealed an aortic aneurysm at descending thoracic aorta until abdominal aorta with 70.9  angulation of the descending thoracic aorta ( Figure 5B). The angulation was then reduced into 50.7  ( Figure 5C). SEAL Thoracic Stent Graft 36 x 200 mm (S&G Biotech, Yongin, Korea) was deployed at descending thoracic aorta ( Figure 5D). Observation for 10 minutes was done, and another evaluation aortography revealed no more endoleak ( Figure 5E). Follow-up CTA after 3 months revealed stent expansion of 18.2 mm at aorta descendent (maximum diameter with thrombus was 56 mm), stent expansion of 29.4 mm at thoracoabdominal aorta (maximum diameter with thrombus was 88.2 mm), no stent migration, and no endoleak was found ( Figure 5F).
case_images: PMC10905129_06
case_images: Thoracic endovacular aortic repair with multiple stiff wire technique of the 6
  th patient.. A. Preoperative volume rendering computed tomography angiography (CTA); B. Initial aortography showed 70.2  and 85.5  angulation of the descending thoracic aorta; C. Two stiff wire was added and straighten the angulation into 54.9  and 52.6 ; D. Stent graft deployment; E. Final aortography; F. Follow up volume rendering CTA after three months.
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case_images: PMC10905129_06_f1000research-12-160558-g0005.jpg
case_images: f6
case_images: TEVAR stent with 72  and 85.4  angulation of the aorta, distal from the previous stent ( Figure 6A). The patient was then prepared for an extension TEVAR procedure. TEVAR stent. There were 70.2  and 85.5  angulations of the descending thoracic aorta ( Figure 6B). The angulations were straightened into 54.9  and 52.6  ( Figure 6C). SEAL Thoracic Stent Graft 36(32) x 130 mm (S&G Biotech, Yongin, Korea) was deployed at descending thoracic aorta until abdominal aorta, overlapped with the previous stent ( Figure 6D). Evaluation aortography revealed good stent position without any endoleak ( Figure 6E). There was an abdominal aortic aneurysm sized 47.33 mm at supra renal and 43.5 mm at infrarenal ( Figure 6F).