Modified use of thoracic and iliac branch endografts to treat an abdominal aortic aneurysm with an unusually narrow neck

Abdominal aortic aneurysms with hostile anatomy are a recognized hindrance to the continuing application of endovascular aortic interventions. Narrowed aneurysm necks pose technical difficulties, particularly in the absence of customized endografts. There are multiple suggested approaches to overcome shortened and angulated necks endovascularly; however, none of these address narrowed necks. We present a case where an endograft was used outside of its “instruction for use” by combining the thoracic and iliac branch technologies to overcome this problem. Expanding the use of commercially available endografts for aortic aneurysms with hostile anatomy could have significant practical and financial benefits.