Hybrid endografts in 'wide neck' abdominal aortic aneurysm in patients unfit for open surgery: The Funnel Technique - Case report and review of the literature

Abstract

Objectives: Abdominal aortic aneurysms with a wide proximal neck (>32 mm) are a contraindication for the use of conventional abdominal endovascular stent grafts because of their limited maximum proximal diameter (36 mm). In these cases, it is customary to resort to sophisticated techniques such as parallel or fenestrated grafts. In very selected cases, such as symptomatic wide neck aneurysm or patient with limited life expectancy, Funnel Technique may find an indication.

Methods: It consists in placing a bifurcated endograft in the abdominal aorta embricated with a thoracic endograft as a proximal cuff in an infrarenal position.

Results: In the literature review, we found 32 cases of this technique, whose characteristics are collected in a table.

Conclusion: The Funnel Technique, taking advantage of the larger diameters of the thoracic prostheses, may easily treat abdominal aortic aneurysm cases with a wide neck.

Keywords: Abdominal aorta aneurysm; EVAR; endoanchors; endoleak; funnel technique; large neck.