Proximal infolding of an Endurant II endograft for barrel-shaped neck: A rare but treatable complication with proximal cuff and coil embolization.

A 75-year-old man with a 55-mm infrarenal abdominal aortic aneurysm underwent endovascular aortic repair. Computed tomography showed a barrel-shaped neck (26 mm at the lowest renal artery, 31.5 mm at 15 mm, and 30.7 mm at 35 mm distal). A 36-mm Endurant II bifurcated graft was deployed. Completion angiography revealed a low-flow endoleak. Postoperative computed tomography demonstrated proximal graft infoldings with a type IA endoleak, likely due to excessive oversizing. Additional endovascular intervention with coil embolization of the gutter and proximal cuff extension eliminated the endoleak. At 12 months, the sac had shrunk, without recurrence.