A 72-year-old man with a known 5.8 cm infrarenal abdominal aortic aneurysm undergoes CT angiography for EVAR planning. Which of the following anatomical features would be an absolute contraindication to standard EVAR?
- A Aortic neck length 20 mm with infrarenal angulation 40°
- B Common iliac artery diameter 12 mm
- C Neck length <10 mm with severe thrombus involving the landing zone ✓
- D Presence of bilateral renal arteries originating from the aneurysm sac
Correct answer: C. Neck length <10 mm with severe thrombus involving the landing zone
Explanation
Standard EVAR requires adequate proximal neck anatomy: length ≥15 mm, diameter 18–32 mm, angulation <60°, and minimal thrombus/calcification. A neck length <10 mm with heavy thrombus in the landing zone precludes adequate seal and is an absolute contraindication to standard EVAR (though fenestrated/branched EVAR may still be possible). A 20 mm neck with 40° angulation is acceptable. Iliac diameter 12 mm is within range for delivery systems. Renal arteries from the sac is an indication for fenestrated EVAR, not absolute exclusion from all EVAR.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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