Penetrating Aortic Ulcer in the Infrarenal Stent-Graft Landing Zone: Treatment with Coils and the Ethylene Vinyl Alcohol Copolymer Onyx

Abstract

Purpose:

To describe a technique to enable endovascular aneurysm repair in patients with penetrating aortic ulcer (PAU) in the infrarenal neck of an abdominal aortic aneurysm (AAA).

Technique:

The technique is illustrated in a 76-year-old man with a 5.7-cm infrarenal AAA and a 2.3times1.8-cm PAU situated immediately distal to the right renal artery and covering 20% of the 28-mm-diameter proximal aortic neck. During the stent-graft repair, the PAU was successfully excluded by embolization with coils and the ethylene vinyl alcohol copolymer Onyx. The AAA and PAU were completely excluded without complications. At 6 months, there were no signs of endoleak, the AAA remained excluded, and there was no reperfusion of the Onyx cast in the PAU.

Conclusion:

This technique for treatment of a PAU in the proximal neck of an AAA is a reasonable alternative in cases involving severely diseased infrarenal necks that would otherwise require open surgery. The liquid embolic agent Onyx performed well, with fast embolization and excellent control of the growing cast maintained by the interventionist.

Keywords

penetrating aortic ulcer endovascular aneurysm repair coil embolization landing zone vinyl alcohol copolymer Onyx infrarenal neck

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