Endovascular Aneurysm Repair Using the ALTO Endograft in a Patient with a Very Tight 10-mm Aortic Bifurcation.

Abstract

Endovascular aneurysm repair (EVAR) is the primary treatment modality for abdominal aortic aneurysms; however, a suitable anatomy is a prerequisite for optimal outcomes. Proximal neck anatomic configuration, including length followed by size and angulation, is the main morphometric characteristic that determines EVAR suitability. Iliac landing zone and access vessels’ adequacy should also be considered [1]. Another characteristic that may affect EVAR feasibility but has received less attention is the presence of a narrow aortic bifurcation (NAB). Data on EVAR outcomes in patients with NAB are scarce and heterogeneous. Overall, EVAR in patients with NAB has been reported to present outcomes similar to those in patients with a standard aortic bifurcation at the expense of considerably more iliac limb stentings and overall adjunctive manipulations during the primary procedure [2,3]. Regarding the definition of NAB, most relevant studies have used a threshold of <20 mm, although <18 mm and <16 mm thresholds have also been used [3]. We report a patient with a very tight 10-mm aortic bifurcation who was successfully treated with an ALTO (Endologix Inc.) endograft (Fig. 1, 2). In this case, simultaneous deployment of the iliac limbs was performed, in contrast to the standard technique in which the contralateral limb is deployed first. Specifically, the