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. 2017 Apr 20;23(2):96-103.
doi: 10.5761/atcs.oa.16-00206. Epub 2017 Mar 23.

Kilt Technique as an Angle Modification Method for Endovascular Repair of Abdominal Aortic Aneurysm With Severe Neck Angle

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Free PMC article

Kilt Technique as an Angle Modification Method for Endovascular Repair of Abdominal Aortic Aneurysm With Severe Neck Angle

Tae-Hoon Kim et al. Ann Thorac Cardiovasc Surg. .
Free PMC article

Abstract

Purpose: Kilt technique can be useful for overcoming the severe angle in endovascular abdominal aortic repair. Thus, we investigate the utility of the Kilt technique as an angle modification method.

Methods: This study included 16 patients with abdominal aortic aneurysm having severe neck angle (over 60°). Of these, eight were treated using Kilt technique, whereas the remaining eight were by the conventional endovascular method. We investigated the pre- and post-procedural differences in neck angle between the two groups using aortic computed tomography (CT) angiography.

Results: Mean pre-procedural neck angles in the conventional group and the Kilt group were 70° ± 13° and 93° ± 14° (p = 0.007) and supra-renal neck angles were 54° ± 16° and 89° ± 26°, respectively (p = 0.016). However, the angle differences disappeared between the two groups after the procedure. Consequently, the Kilt group showed greater angle change than the conventional group (p value for ∆ supra-renal angle and ∆ neck angle were 0.015 and 0.021, respectively). There was no type 1 endoleak during 16 ± 16 months of CT follow-up.

Conclusion: Kilt technique may be an effective tool for modifying the neck angle without leaving increased risk of type 1 endoleak in this subset of patients.

Keywords: Kilt technique; abdominal aortic aneurysm; endovascular abdominal aortic repair.

Figures

Fig. 1
Fig. 1
An illustration indicated types of severe angulated abdominal aortic aneurysm. Type A is defined as severe angulation only present at the renal neck. Types B and C represented that significant SRNA (>30° of angle) is present with severe renal neck angle (>60° of angle); type B is defined as position of supra-renal angle is located above the both renal arteries; type C is the supra-renal angle that is present lower than both renal arteries. RNA: renal neck angle; SRNA: supra-renal neck angle
Fig. 2
Fig. 2
A case using Kilt technique shows the patient with abdominal aortic aneurysm and bilateral iliac artery aneurysms. A and E revealed pre- and post-procedural CT images and B, C, and D indicated procedural aortographic images of patient. (A) Pre-procedural CT angiography shows severe neck (closed arrow head) and supra-renal neck (open arrow head) angles. (B) An aortic cuff is placed at the level of both renal arteries. (C) A main body with sheath is prepared for deploy, inside of previously deployed aortic cuff. (D) Aortography after Kilt endovascular procedure shows no type 1 endoleak, an arrow indicated aortic cuff previously deployed for the main body (typical feature in post-procedure CT of Kilt procedure). (E) Post-procedural CT angiography shows no leaks from each side of device tips. White arrow indicates distal tip of aortic cuff. CT: computed tomography

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