A Word of Caution for Extra Large Self-expandable Nitinol Stents

Ann Vasc Surg . 2017 Jul;42:305.e1-305.e5. doi: 10.1016/j.avsg.2016.12.010. Epub 2017 Apr 5.

Fecha de la publicación: 05/04/2017

Autor: Andrés Reyes Valdivia (1), Africa Duque Santos (2), Francisco Alvarez Marcos (3), Asunción Romero Lozano (2), Julia Ocaña Guaita (2), Claudio Gandarias Zúñiga (2)



1Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain. Electronic address: cauzaza@hotmail.com.

2Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain.

3Department of Vascular and Endovascular Surgery, Juan Canalejo’s University Hospital, A Coruña, Spain.


Background: To report an unsuccessful use of large nitinol stent to prevent proximal endoleak in endograft treatment for juxtarenal aortic aneurysm.

Case report: An 82-year-old male presented coronary disease and severe chronic obstructive pulmonary disease requiring oxygen support. A large 80-mm juxtarenal aneurysm was found on routine urological examination. Neck features were as follows: 7 mm and high anterior-posterior angulation. ASA risk score IV was given. Patient wanted to be treated. We decided a 1-shot intervention based on self-expandable suprarenal fixation endograft with adjunctive extra large self-expandable (high radial force) nitinol stent. Control computed tomography scan demonstrates nitinol stent severe infolding and a possible perforation of the primary endograft. At 6-month follow-up, sac reveals enlargement of 5 mm and 6% volume increase. Patient does not want further treatments due to high risk of procedures.

Conclusions: Extreme caution should be taken when using self-expandable extra large nitinol stents for preventive matters. Oversizing should be carefully considered, not necessarily reaching the endograft chosen size. When short and angulated neck morphology co-exists, other devices or procedures may be a better option.