Charlotte Gonthier1, Sebastien Deglise2, Vincenzo Brizzi1, Eric Ducasse3, Dominique Midy3, Mario Lachat4, Xavier Berard5. 1. Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France. 2. Vascular Surgery Department, CHUV, Lausanne, Switzerland. 3. Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France. 4. Vascular Surgery Department, Zurich University Hospital, Zurich, Switzerland. 5. Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France. Electronic address: xavier.berard@chu-bordeaux.fr.
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.
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.
Authors: Claire van der Riet; Richte C L Schuurmann; Angelos Karelis; Mehmet A Suludere; Meike J van Harten; Björn Sonesson; Nuno V Dias; Jean-Paul P M de Vries; Martijn L Dijkstra Journal: J Clin Med Date: 2022-02-23 Impact factor: 4.241