Transrenal E-XL stenting to resolve or prevent type Ia endoleak in the case of severe neck angulation during endovascular abdominal aortic aneurysm repair

During endovascular abdominal aortic aneurysm repair, a severely angulated neck can make proximal sealing of endografts challenging, and the occurrence of a type Ia endoleak can complicate the procedure. We describe an original adjunctive procedure involving transrenal placement of a self-expanding nitinol stent (E-XL aortic stent; Jotec GmbH, Hechingen, Germany) to remodel the proximal aortic neck and treat or prevent type Ia endoleaks in the case of severe angulation of the proximal neck.