Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique)
Abstract Background The Endovascular Repair (EVAR) is the first-choice technique for Abdominal Aortic Aneurysm (AAA). Treatment success is dependent on favorable anatomy and an adequate sealing zone formed by a straight aortic neck (slightly angled). Endoprostheses implanted at critical aortic angl...
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Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
2025-02-01
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| Series: | Jornal Vascular Brasileiro |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492025000100303&lng=en&tlng=en |
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| author | André Pinheiro Ribeiro Alves Queise da Costa Cettolin Yasmin Falcon Lacerda Mauricio de Amorim Aquino Gustavo dos Santos Domingues |
| author_facet | André Pinheiro Ribeiro Alves Queise da Costa Cettolin Yasmin Falcon Lacerda Mauricio de Amorim Aquino Gustavo dos Santos Domingues |
| author_sort | André Pinheiro Ribeiro Alves |
| collection | DOAJ |
| description | Abstract Background The Endovascular Repair (EVAR) is the first-choice technique for Abdominal Aortic Aneurysm (AAA). Treatment success is dependent on favorable anatomy and an adequate sealing zone formed by a straight aortic neck (slightly angled). Endoprostheses implanted at critical aortic angles (above 75º) may result in unfavorable results such as fracture, migration, and type Ia endoleak. The technique for creating a proximal “Neoneck” consists of implanting the Palmaz stent in the proximal neck of the AAA, before placement of the endoprosthesis, allowing remodeling and rectification of the aortic neck. Objectives To describe the “Neoneck” technique and report the early results of three cases with rectification of the proximal neck angle using a Palmaz stent, enabling treatment in these cases with angulated necks. Methods We analyzed data collected from patients in whom Palmaz stents were placed, constructing a proximal Neoneck, during EVAR for infrarenal AAA with very tortuous proximal aortic neck, assessing anatomy, devices and perioperative results, including success rates, complications, mortality, and patency in the short and medium term. Results All patients presented satisfactory evolution with immediate technical success. There were no cases of migration, fracture, or type Ia endoleaks. There was evidence of aneurysmal sac reduction after six months. There were no complications related to surgical access or deaths. Conclusions In cases of angled aortic necks, when open AAA repair is not possible, in the absence of ideal devices or in urgent cases, prior rectification of the aortic neck deploying the Palmaz stent is feasible and effective. Long-term studies are still needed to validate the technique and assess safety. |
| format | Article |
| id | doaj-art-666234ce55174b8fbfb4f003dc83f3b8 |
| institution | DOAJ |
| issn | 1677-7301 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) |
| record_format | Article |
| series | Jornal Vascular Brasileiro |
| spelling | doaj-art-666234ce55174b8fbfb4f003dc83f3b82025-08-20T02:46:28ZengSociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)Jornal Vascular Brasileiro1677-73012025-02-012410.1590/1677-5449.202400452Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique)André Pinheiro Ribeiro Alveshttps://orcid.org/0000-0003-3755-9900Queise da Costa Cettolinhttps://orcid.org/0000-0001-5289-6695Yasmin Falcon Lacerdahttps://orcid.org/0000-0002-7545-212XMauricio de Amorim Aquinohttps://orcid.org/0000-0001-5472-6577Gustavo dos Santos Domingueshttps://orcid.org/0000-0001-8966-8207Abstract Background The Endovascular Repair (EVAR) is the first-choice technique for Abdominal Aortic Aneurysm (AAA). Treatment success is dependent on favorable anatomy and an adequate sealing zone formed by a straight aortic neck (slightly angled). Endoprostheses implanted at critical aortic angles (above 75º) may result in unfavorable results such as fracture, migration, and type Ia endoleak. The technique for creating a proximal “Neoneck” consists of implanting the Palmaz stent in the proximal neck of the AAA, before placement of the endoprosthesis, allowing remodeling and rectification of the aortic neck. Objectives To describe the “Neoneck” technique and report the early results of three cases with rectification of the proximal neck angle using a Palmaz stent, enabling treatment in these cases with angulated necks. Methods We analyzed data collected from patients in whom Palmaz stents were placed, constructing a proximal Neoneck, during EVAR for infrarenal AAA with very tortuous proximal aortic neck, assessing anatomy, devices and perioperative results, including success rates, complications, mortality, and patency in the short and medium term. Results All patients presented satisfactory evolution with immediate technical success. There were no cases of migration, fracture, or type Ia endoleaks. There was evidence of aneurysmal sac reduction after six months. There were no complications related to surgical access or deaths. Conclusions In cases of angled aortic necks, when open AAA repair is not possible, in the absence of ideal devices or in urgent cases, prior rectification of the aortic neck deploying the Palmaz stent is feasible and effective. Long-term studies are still needed to validate the technique and assess safety.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492025000100303&lng=en&tlng=enendovascular aortic repairinfrarenal abdominal aortic aneurysmtortuous neckhostile neckproximal neoneckPalmaz stent |
| spellingShingle | André Pinheiro Ribeiro Alves Queise da Costa Cettolin Yasmin Falcon Lacerda Mauricio de Amorim Aquino Gustavo dos Santos Domingues Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique) Jornal Vascular Brasileiro endovascular aortic repair infrarenal abdominal aortic aneurysm tortuous neck hostile neck proximal neoneck Palmaz stent |
| title | Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique) |
| title_full | Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique) |
| title_fullStr | Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique) |
| title_full_unstemmed | Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique) |
| title_short | Infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal Palmaz stent followed by an endoprosthesis with suprarenal fixation (the “Neoneck” technique) |
| title_sort | infrarenal endovascular repair of abdominal aortic aneurysm with hostile aortic neck configuration by primary placement of an infrarenal palmaz stent followed by an endoprosthesis with suprarenal fixation the neoneck technique |
| topic | endovascular aortic repair infrarenal abdominal aortic aneurysm tortuous neck hostile neck proximal neoneck Palmaz stent |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492025000100303&lng=en&tlng=en |
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