PMC6911893_01
Computed tomography imaging. (A) Computed tomography shows an infrarenal abdominal aortic aneurysm with a short left common iliac artery. (B) The proximal neck is long, narrow, and moderately angulated (55 ). The aneurysmal sac is thrombus free, and the angle between the aneurysm sac and the right common iliac artery is 63 .
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A 76 year old woman was admitted to hospital with an asymptomatic abdominal aortic aneurysm (AAA), which had a maximum diameter of 53 mm (Fig. 1).
Abdominal Xray images on the day after the endovascular abdominal aortic repair procedure and schematic model of the ipsilateral limb twisting of the Gore Excluder. (A) The evaluation of the shape of the ipsilateral limb was difficult because of the overlapping images of the ipsilateral and contralateral limbs. (B) The magnified image shows ipsilateral limb stenosis (arrows) and twisting, which is reproduced in (C.).
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Careful review of the abdominal imaging revealed twisting of the Excluder in the ipsilateral leg (Fig. 2).
Intravascular ultrasound and intra-operative fluoroscopy imaging. Intravascular ultrasound (IVUS) images of a stent graft in the main trunk (A), orifice of the ipsilateral limb (B), narrowest point of the ipsilateral limb (C), and left common iliac artery (D). The main trunk and ipsilateral limb in the left common iliac artery show no stenosis. The stenosis of the ipsilateral limb starts from its orifice. At the narrowest point, only a small space is observed outside of the IVUS probe. (E) Intra-operative fluoroscopy image, which was rotated to separate the two limbs, shows an approximately six cm twisting of the ipsilateral limb.
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However, during IVUS, severe stenosis of over 60 mm in length was observed from the bifurcation of the ipsilateral limb (Fig. 3).
Post-operative computed tomography imaging. (A) Post-operative computed tomography images show no evidence of endoleaks. The bare stent (B: a, b, c) is well dilated, with no visible stenosis. LA: left anterior, AR: anterior right, RP: right posterior, PL: posterior left, LSA: left superior-anterior, RIP: right inferno-posterior.
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Post-operative computed tomography revealed no stenosis of the ipsilateral limb or evidence of endoleaks (Fig. 4).