A narrow-waisted abdominal aortic aneurysm complicating endovascular repair

Purpose: To present a case in which a narrow waist in an abdominal aortic aneurysm (AAA) complicated endovascular repair using a modular bifurcated stent-graft. Methods and Results: A 68-year-old man underwent endovascular repair of a 5.9-cm asymptomatic AAA with a self-expanding modular bifurcated stent-graft. After insertion and deployment of the stent- graft, the intraoperative completion angiogram disclosed unexpected incomplete deployment of the contralateral iliac limb due to a narrow waist in the aortic aneurysm. Subsequent angioplasty did not increase iliac stent- graft diameter. At follow-up, a tapered course of the contralateral iliac leg persisted, without hemodynamic significance. Conclusions: A narrow waist in an AAA may be considered an additional important anatomical characteristic in assessing suitability for endovascular repair.