Page 22 - Virtual Vascular Vol 21
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AAA Inverted Funnel Neck
AAA inverted funnel.mp4
A 70-year-old man presented with a pulsatile abdominal mass. CT scan (video)
showed a 5.4 cm diameter infrarenal abdominal aortic aneurysm (AAA). Surgical in-
tervention is generally offered to patient with an AAA greater than 5cm in diameter.
Options of treatment including endovascular repair (EVAR) and open surgery were
discussed. Although this aneurysm is infrarenal, the infrarenal neck has an “inverted
funnel” morphology (Figure 1 and Figure 2) making standard EVAR may not be dura-
ble.
Options include;
Standard EVAR with endoanchors to the neck region so as to prevent distal migration
Fenestrated graft with stenting to renal arteries so as to land above the renal arter-
ies to obtain a better proximal landing zone
Open repair- accepting the increased perioperative risk
After thorough discussion, the patient opted for open repair of his AAA. Intraoper-
ative photo (Figure 3) shows an inverted funnel neck marginal for standard EVAR.
Open repair with interposition bifurcated graft was performed (Figure 4)
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