Technical Characteristics of the Ovation Alto for the Treatment of Abdominal Aortic Aneurysms: Application to Challenging Anatomies

Figures

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  Fig. 1. ( A ) Case 1 aneurysm with wide neck. ( B )The proximally angulated infrarenal neck at 10mm below the renal level. ( C ) Efficient sealing relies on the adjusted apposition on the conical neck irregularities. ( D )The postoperative computed tomography angiography at one month shows efficient apposition of the inflatable rings at the sealing level, with no endoleaks.

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  Fig. 2. The juxtarenal aortic aneurysm of case 2. The arrowhead shows the pair of sealing rings accommodated against the thrombus surface in this computed tomography with IV contrast.

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  Fig. 3. ( A ) The short-necked aneurysm of case 3. Note the infrarenal angulation of the neck. ( B ) Coronal plane of the 1-month no-contrast postoperative follow up, showing the accurate apposition of the sealing rings immediately infrarenally. ( C ) The lack of any fabric zone between the proximal bare stent and the sealing rings does not restrict the flexibility of the endograft to adjust efficiently in this short and angulated neck. ( D )The endograft adapts efficiently to the curvature between the supra- and infrarenal angulation despite the long proximal stent and the short main body.

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  Fig. 4. ( A )The aortic aneurysm of the fourth case with reverse tapered neck. ( B )The pair of sealing rings in the 1-month postoperative follow-up accommodating perfectly in the conical neck configuration (dashed lines).

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  Fig. 5. Representation of deployment of Ovation Alto in an abdominal aortic aneurysm with significant infrarenal neck angulation. The narrow distance between the unsupported main body and the limb gates can lead to positioning of the latter at a site of steep angle, predisposing to kinking.