PMC5576004_01
(A) Suprarenal abdominal aortic aneurysm measuring 1.3 x 0.9 cm (axial). (B) Suprarenal abdominal aortic aneurysm measuring 1.3 x 0.9 cm (coronal). (C) Left proximal iliac artery aneurysm measuring 2.6 x 1.3 cm (axial). (D) Left proximal iliac artery aneurysm measuring 2.6 x 1.3 cm (coronal).
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A diagnostic computed tomography (CT) scan of the thorax, abdomen, and pelvis showed new saccular mycotic aneurysms in the suprarenal abdominal aorta and proximal left common iliac artery that persisted and increased in size on follow up CT angiogram (CTA) in November 2014 (Fig. 1).
(A,B) Rimming the fenestrations by securing a 0.014 inch soft Command wire (Abbott Vascular) end with prolene 7/0 suture. (C) Molding the wire along the circumference of the fenestration. (D) Wire reinforced fenestrations 8 mm wide 17 mm apart at the 12 o'clock position made on a partially deployed Cook thoracic stent graft based on accurate CT measurements.
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The graft was then resheathed (Fig. 2).
(A) Initial angiogram showing the suprarenal abdominal aortic aneurysm. (B) Oblique angiogram confirming the rotational anatomy of the celiac artery and SMA fenestrations in relation to the deployed stents. (C) Contrast CT with CA and SMA stents in situ (sagittal view).
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Ansel guiding sheaths (Cook). Atrium 7 mm x 22 mm and 9 mm x 38 mm covered stents were then deployed through the sheaths and respectively flared out (Fig. 3).
(A) Angiogram showing the proximal left common iliac artery aneurysm. (B) Bilateral iliac artery atrium stents deployed using a parallel endograft approach.
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Bilateral CIA Atrium stents (16 mm x 61 mm on the right and 12 mm x 61 mm on the left) were deployed using a parallel endograft approach (Fig. 4).