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Updated: Feb 19, 2026
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
The Cuff Plus Anchoring Funnel Technique for Endovascular Aortic Repair (CAF-EVAR) for Large Infrarenal Necks
Andrés Reyes Valdivia1, Africa Duque Santos2, Julia Ocaña Guaita2
1Department of Vascular and Endovascular Surgery, Ramón y Cajal´s University Hospital, Madrid, Spain. cauzaza@hotmail.com.
Purpose:
To present a case of a patient with possible short (2 years approximately) life expectancy and a 68-mm abdominal aortic aneurysm with a large infrarenal neck and large suprarenal aorta that precluded chimney endovascular aortic repair (Ch-EVAR) treatment.
Materials And Methods:
The technical aspects of a modification of the funnel technique (thoracic endograft as a proximal extension of a main infrarenal device in wide necks) are described. We advocated a migrated bifurcated 36-mm endograft in a 34-mm native aorta, ten mm below the lowest renal artery and added endoanchor (four) fixation to this "intentionally migrated main endograft." Afterward, we extended proximally a large aortic 38-mm-wide/50-mm-long cuff using the remaining 10-mm neck for cuff sealing. This aortic cuff achieved 8.5% oversizing in this 10-mm neck length. We again added additional endoanchoring (four) on this cuff.
Results And Conclusions:
Insights into technical issues for this bailout technique are described. No proximal endoleak or sac enlargement or migration is founded on 6-month follow up.
