Hemodynamic Conditions May Influence the Oversizing of Stent Grafts and the Postoperative Surveillance of Patients With Ruptured Abdominal Aortic Aneurysm Treated by EVAR

Ann Vasc Surg. 2016 Jan;30:308.e5-10. doi: 10.1016/j.avsg.2015.07.032. Epub 2015 Oct 30.

Abstract

Background: To report the causes of second rupture in patients treated with a stent graft for ruptured abdominal aortic aneurysm (rAAA).

Case report: A 69-year-old man was admitted for abdominal pain and hypovolemic shock 22 months after endovascular exclusion of an rAAA with an aortomonoiliac stent graft and a crossover bypass despite normal duplex ultrasound and sac shrinkage at 1 year. During emergent laparotomy, a type IA endoleak was discovered and the aortomonoiliac stent graft was explanted. A Dacron bypass was interposed between the infrarenal aorta and the iliac extension stent graft.

Conclusions: Considering the literature, this report has 3 implications for the endovascular treatment of rAAA. First, 30% oversizing is preferable to 15% when treating an rAAA assessed by computed tomography angiography (CTA) performed during permissive hypotension. Second, the surveillance program should rely on CTA and not on a duplex examination to detect any endoleaks or migration. Finally, partial stent graft explantation is a valid option for decreasing aortic clamping time.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / complications
  • Aortic Aneurysm, Abdominal / diagnosis
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture / diagnosis
  • Aortic Rupture / etiology
  • Aortic Rupture / surgery*
  • Blood Vessel Prosthesis / adverse effects*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Endoleak / diagnosis
  • Endoleak / etiology
  • Endoleak / surgery
  • Endovascular Procedures / adverse effects*
  • Humans
  • Hypotension / complications*
  • Male
  • Prosthesis Fitting / adverse effects
  • Stents / adverse effects*