Limb occlusion after endovascular repair of an abdominal aortic aneurysm: beware the narrow distal aorta

This case aims to highlight the need for careful scrutiny of the distal aorta during endovascular aneurysm repair (EVAR) planning to avoid potentially avoidable graft limb occlusion. We present a case of graft limb occlusion after EVAR, unresponsive to endovascular re-intervention requiring surgical extra-anatomic revascularization, due to a narrow distal aorta causing graft impingement and collapse. We suggest clinicians should be aware of this potential pitfall during EVAR planning and beware the narrow distal aorta.