PMC5971266_01
Crescent sign of suprarenal aortic aneurysm (a). A-phase shows saccular aneurysm behind the pancreas (b). Coronal view: suprarenal saccular aneurysm mainly on the left side (c). Sagittal view: aneurysm bulge anteriorly displacing the pancreas (d).
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fig1
Computed tomographic angiography revealed a saccular aneurysm at the paravisceral aortic region, a nearly occluded celiac artery, and superior mesenteric artery with a large patent inferior mesenteric artery (7.3 mm), which provided a large collateral in the retroperitoneal space for supplying visceral organs, as shown in Figure 1.
Proximal landing zone with diameter of 22 mm (a). Distal landing zone with diameter of 20 mm (b). Coronal view shows inflammatory and saccular aneurysm part (c).
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fig2
T10-11 with a diameter of 24 mm and the distal landing zone to be 20 mm in diameter above the IMA. The distance from the proximal landing zone to just above renal arteries was 90 mm, as shown in Figure 2.
Intraoperative angiogram shows suprarenal saccular aneurysm with nearly occluded celiac and superior mesenteric artery (a). Large patent of inferior mesenteric artery gives blood supply to whole abdomen (b). Endoleak type III from left gutter (c). Extended gutter and coil embolization between left renal stent and aortic stent (d).
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fig3
In final aortogram, there is only endoleak type 2, as shown in Figure 3.
CTA: axial view, no endoleak (a). Sagittal view: stent placed superior to inferior mesenteric artery orifice (b). Reconstruction view: adequate flow from the inferior mesenteric artery to supply the celiac artery and superior mesenteric artery.
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fig4
Computed tomographic angiography results revealed that the aneurysm had shrunk, as shown in Figure 4 (three months after surgery).
C-reactive protein levels from preoperation to 12 weeks after endovascular aneurysm repair (EVAR) by using the sandwich technique.
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fig5
We also found that C-reactive protein (a biomarker) levels were dramatically lower after the aneurysm was repaired and returned to normal after three weeks (Figure 5).