Overcoming Anatomical Constraints: A Case of Successful Endovascular Repair in a High-Risk Patient With a Short, Angulated Abdominal Aortic Aneurysm

Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is often limited by anatomical factors such as short necks (less than 15 mm) and significant angulation (over 60 degrees), making EVAR unsuitable. We present a case of a 60-year-old man with multiple comorbidities and a short, markedly angulated AAA neck. Despite being deemed unsuitable for EVAR, the patient underwent successful EVAR with the chimney technique. At the one-month follow-up, the patient had no complications, stable renal function, and no detected endoleak or other complications on routine CT scans. Cardiac tests were normal. This case challenges traditional contraindications and highlights the potential for EVAR in challenging anatomical situations. Incorporating the chimney technique and reinforcing the proximal neck can prevent complications, while future research should focus on tailored EVAR strategies addressing individual needs and anatomical challenges.