case_images: PMC10766741_01
case_images: Fig. 1 Preoperative 3-dimensional reconstruction and CTA. (A) 3-dimensional reconstruction confirmed infrarenal AAA with severely angulated neck. Aneurysmal dilatation of left common iliac artery and atherosclerotic atheroma of bilateral iliac arteries were observed. (B) Preoperative CTA showed the infrarenal AAA with a saccular aneurysm (white arrow) due to a PAU in the proximal landing zone. CTA: computed tomography angiography; AAA: abdominal aortic aneurysm; PAU: penetrating atherosclerotic ulcer.
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case_images: PMC10766741_01_avd-16-261-g001.jpg
case_images: figure1
case_images: In addition, a saccular aneurysm due to a PAU was found in the proximal landing zone (Fig. 1A). In this case, the PAU ulcer area was localized and intimal continuity was relatively continuous; therefore, we expected that a coil embolization for the saccular aneurysm would secure the proximal landing zone (Fig. 1B).
case_images: Fig. 2 Angiography during the procedure. (A and B) The tip of the KMP (Torcon NB ; Cook) catheter introduced from the right femoral artery was placed in a saccular aneurysm of the proximal landing zone. An Excluder main body was deployed below the origin of the lowest renal artery over the tagging wire. (C-E) Coil embolization of the saccular aneurysm through the KMP catheter confirmed no blood flow inside the aneurysm by aortography. It also showed favorable stent-graft positions without Type 1A endoleak.
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case_images: PMC10766741_01_avd-16-261-g002.jpg
case_images: figure2
case_images: After completion of body floss technique from the right brachial artery to the left femoral artery (Radifocus; Terumo, Tokyo, Japan), a pig-tail catheter was introduced into the suprarenal aorta from the left radial artery (Fig. 2A). Terumo, Tokyo, Japan) was introduced from the right femoral artery. The tip of the KMP (Torcon NB ; Cook, Bloomington, IN, USA) catheter introduced from the right femoral artery was deployed into the saccular aneurysm of the proximal landing zone (Fig. 2B). Gore & Associate) was deployed below the origin of the lowest renal artery over the tagging wire (Figs. 2B and 2C). We then performed coil embolization of the saccular aneurysm through the KMP catheter using 10 coils (Tornado 100 mm length; Cook) and confirmed blood flow stoppage inside the aneurysm by aortography (Fig. 2D). Associate) was sequentially deployed proximal to the opening of the right internal iliac artery. Aortography confirmed complete sealing of the complex AAA with patency of the bilateral renal arteries, external and internal iliac arteries (Fig. 2E).
case_images: Fig. 3 Postoperative 3-dimensional reconstruction and CTA at 1-year follow-up. (A) 3D reconstruction showed favorable stent-graft positions without Type 1A endoleak or leg obstruction. (B) Postoperative CTA showed favorable stent-graft positions without Type 1A endoleak (yellow arrow). However, it showed the Type II endoleak from the lumbar artery (white arrow). CTA: computed tomography angiography.
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case_images: PMC10766741_01_avd-16-261-g003.jpg
case_images: figure3
case_images: Follow-up computed tomography angiography (CTA) at postoperative 1 year demonstrated favorable stent-graft positions without Type IA endoleak or migration, but with Type II endoleak from the lumbar artery (Figs. 3A and 3B).