Endovascular Exclusion of Saccular AAAs Using “Stacked” AneuRx Aortic Cuffs

Purpose: To show that AneuRx aortic cuffs might be used in a “stacked” configuration to effectively treat saccular abdominal aortic aneurysm (AAA). Methods: In a recent 1-year period, 147 patients underwent endovascular AAA repair. Of these, 5 (4 men; mean age 61.6 years, range 55–69) had saccular AAAs with a mean diameter of 3.7 ± 0.2 cm (range 3.0–4.7). AneuRx aortic cuff prostheses (3.75-cm length) were deployed sequentially in these 5 patients via a right femoral approach; the devices were overlapped ∼1.5 to 2.0 cm until complete exclusion of the aneurysm was achieved. Endograft surveillance was performed using computed tomography at 4 weeks postoperatively and then every 6 months. Results: Successful exclusion of the saccular infrarenal aortic aneurysms was achieved in all 5 patients using 2 or 3 “stacked” stent-graft extensions. Four of the 5 procedures were performed under spinal anesthesia; the average procedural time was 96 ± 41 minutes. The average hospital length of stay was 1.6 days; no major morbidity or mortality was encountered. There were no early or late endoleaks, aneurysm expansion, or device migration over a follow-up that ranged to 12 months. Conclusions: Saccular AAA provides ideal anatomy for endovascular repair with a “tube” endograft. “Stacked” aortic cuffs create a customized stent-graft that is not otherwise commercially available.