A 65-year-old man with a 6 cm infrarenal abdominal aortic aneurysm is being considered for endovascular aortic repair (EVAR). Which anatomical criterion is a contraindication to standard EVAR?
- A Bilateral common iliac artery diameter >15 mm
- B Proximal neck length <15 mm or neck angulation >60° ✓
- C Infrarenal aortic neck diameter >28 mm
- D Aneurysm sac length >8 cm
Explanation
Standard EVAR requires adequate proximal and distal landing zones. A proximal neck length of <10–15 mm (device-specific) or excessive neck angulation (>60° for most devices) prevents adequate seal and fixation, leading to type I endoleak and device migration. Other contraindications include severe neck thrombus or calcification, and inadequate iliac access. Bilateral large common iliac arteries (>20 mm) may limit sealing but are not an absolute contraindication as bell-bottom or flared limb devices can be used. Aneurysm sac length and neck diameter per se do not preclude EVAR.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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