1. Endovascular management of complicated AAA 复杂腹主动脉瘤的腔内修复治疗 Department of Vascular Surgery, Xiang-Ya Second Hospital, Central-South University 中南大学湘雅二 医院血管 Chang Shu 舒 畅

2. Case one Severe calcification + tortuosity

3. Case one Male 73 years old Severe calcification in the abdominal aorta and bilateral iliac As. There is a sharp angle ( ≈ 80°) between the abdominal A and the right iliac artery. And the proximal neck is very tortuous.

4. Pre-operation

5. treatment A stiff guide wire was utilized to straighten the sharp angle between the abdominal aorta and the right iliac A.

6. Post-operation

8. Case two Tuberculous mycotic abdominal aortic pseudo-aneurysm

9. Female 52 years old Fever for 2 weeks. X-ray indicated TB. Abrupt abdominal pain, especially in the medial and back. Case two

10. CTA pre-operation

14. MRI pre-operation

15. treatment Conservative anti-tuberculosis therapy was used before admission, and the symptoms relieved. EVAR was then performed to repair the pseudo-aneurysm.

16. Follow-up

18. The pseudo-aneurysm was totally excluded by stent graft. No migration, infection of the stent graft, endoleak and so on. All symptoms relieved.

19. Discussion Conservative anti-tuberculosis therapy alone is insufficient to tuberculous mycotic abdominal aortic aneurysm/pseudo- aneurysm. Medication associated with surgery is appropriate.

20. Discussion Open surgery, such as prosthesis graft bypass, extra-anatomic bypass, also can be used. EVAR is a good alternative for Tuberculous mycotic abdominal aortic pseudo-aneurysm.

21. Case three Severe torque of the iliac artery

22. Severe torque of the iliac artery is not a problem.

23. Case four Single arm AAA stent-graft

25. Case five Severe torque of the iliac artery

26. Severe torque of bilateral iliac As

28. Case six Short proximal neck

29. AAA case with the proximal neck less than 0.5 cm, and tortuous proximal site.

31. EVAR

32. Case seven Associated with giant iliac artery aneurysm and several tortuous site

33. CT pre-operation

34. CTA pre-operation Severely tortuous in the proximal site. Bilateral common iliac aneurysm, especially the left one, associated with bilateral internal iliac arteries. Severe tortuosity of the right common iliac artery.

35. CTA pre-operation Severely tortuous in the proximal site. Bilateral common iliac aneurysm, especially the left one, associated with bilateral internal iliac arteries. Severe tortuosity of the right common iliac artery.

36. Because of the hemodynamic and anatomic reasons, angiography of the left iliac artery was not achieved. So, DSA had to be performed to indentify the definite situation.

37. DSA

40. Case eight Giant AAA associated with several tortuous site

42. Two stiff guide wires were utilized to straighten the sharp angle of the left iliac artery.

44. Case night Giant AAA associated with several tortuous site

49. Discussion

50. How to make the decision: open surgery or endoluminal technique? 1.the location and anatomic conditions of the aneurysm. 2.the condition of the patient: age, co-morbidity and so on. 3.financial support.

51. Thank you very much!