The Cuff Plus Anchoring Funnel Technique for Endovascular Aortic Repair (CAF-EVAR) for Large Infrarenal Necks

• Published in: Cardiovascular and interventional radiology Vol. 41; no. 2; pp. 330 - 335
• Main Authors: Reyes Valdivia, Andrés, Duque Santos, Africa, Ocaña Guaita, Julia, Gandarias Zúñiga, Claudio
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2018; Springer Nature B.V
• Subjects: Aged; Anchoring; Aneurysms; Aorta; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - surgery; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Bifurcations; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Cardiology; Cardiovascular system; Coronary vessels; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Enlargement; Humans; Imaging; Life expectancy; Life span; Male; Medicine; Medicine & Public Health; Migration; Neck; Nuclear Medicine; Prosthesis Design; Radiology; Renal artery; Technical Note; Thorax; Treatment Outcome; Ultrasound; EVAR; Aortic cuff; Endoanchors; Endograft; Large neck
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-017-1819-6

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.