Endotension after Abdominal Aortic Aneurysm Endovascular Repair in Cirrhotic Patients

Ann Vasc Surg. 2017 Nov:45:265.e5-265.e8. doi: 10.1016/j.avsg.2017.06.148. Epub 2017 Jul 6.

Abstract

Background: Endotension can present a real challenge for the long-term success of endovascular aortic repair (EVAR). Sometimes, it can be associated with liver dysfunction and consequent plasmatic alterations as in the 2 cases reported here.

Methods: Significant and progressive abdominal aortic aneurysms (AAA) sac enlargement, without radiologic signs of endoleak, was observed in 2 patients during a 3-year follow-up after EVAR. The first was a 70-year-old man affected by viral liver cirrhosis and the second was a 71-year-old man with cirrhosis due to alcoholic liver disease.

Results: Both patients underwent successful conversion to open AAA repair; intraoperative findings confirmed the diagnosis of endotension.

Conclusions: Cirrhosis-induced plasmatic alterations may affect long-term efficacy of EVAR and should be considered when weighing endovascular treatment against open AAA repair in these high-risk patients. Surgical conversion is feasible despite the high procedural risk associated with liver disease.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / complications
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / physiopathology
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Computed Tomography Angiography
  • Drainage
  • Endovascular Procedures / adverse effects*
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnostic imaging
  • Liver Cirrhosis / physiopathology
  • Liver Cirrhosis / virology
  • Liver Cirrhosis, Alcoholic / complications*
  • Liver Cirrhosis, Alcoholic / diagnostic imaging
  • Liver Cirrhosis, Alcoholic / physiopathology
  • Male
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Postoperative Complications / physiopathology
  • Postoperative Complications / therapy
  • Risk Factors
  • Treatment Outcome