Predeployed aortic extension cuff (kilt) in EVAR with hostile neck anatomy using Endurant II system: preliminary...

Various modifications of standard endovascular aortic aneurysm repair (EVAR) have been developed to solve the problem of difficult neck anatomy.

The authors propose the implantation of a predeployed extension cuff (kilt) using on-shelf Endurant II elements. In a vast majority of cases, the proposed method provides a solution for the hostile neck problem using standard Endurant II elements available in all centers performing subrenal EVAR procedures.

The early outcomes of kilt implantation were evaluated in 11 patients (three with ruptured abdominal aortic aneurysms, one symptomatic) in 2 vascular centers in Silesia (Poland). All patients presented with hostile neck anatomy defined as neck length < 10 mm, diameter > 28 mm, angulation > 60°, mural thrombus or calcium > 2 mm in thickness or > 180° circumference.

No intraoperative type I endoleak or device migration was observed. Two perioperative deaths occurred in patients in a severe condition with ruptured aneurysms. One case of type III endoleak was managed by the implantation of an additional iliac extension with complete endoleak sealing.

The proposed method seems to be effective in early endoleak prevention in patients with hostile neck anatomy undergoing EVAR procedures; however, studies with long-term follow-up are needed.