Neck remodeling using the amplatzer vascular plug to facilitate endovascular repair of a contained abdominal aortic rupture.

PURPOSE: To describe the use of an Amplatzer Vascular Plug to facilitate endovascular aneurysm repair (EVAR) in a renal transplantation recipient with contained rupture of an abdominal aortic aneurysm (AAA). CASE REPORT: A 52-year-old man with a history of kidney transplantation and a 4-cm AAA was referred to our hospital with severe abdominal pain. Imaging showed the contained AAA rupture measuring 8 cm, with 2 blisters at the proximal short neck and narrow calcified iliac arteries. The blisters were the probable sites of rupture, and the cranial one was 4 mm below the superior mesenteric artery, precluding conventional EVAR. The Amplatzer Vascular Plug was used to occlude the blister and remodel the proximal neck so that a low-profile Ovation prosthesis could be passed through the narrow calcified iliac artery without damaging the transplanted renal artery anastomosed to the external iliac artery. CONCLUSION: The unconventional use of the Amplatzer Vascular Plug for neck remodeling made EVAR possible in this case