Rupture of abdominal aortic aneurysm with shrinkage after endovascular repair

Division of Vascular Surgery, Department of Surgery, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama-city, Ibaraki, 309-1793, Japan.
Asian cardiovascular & thoracic annals 08/2012; 20(4):469-71. DOI: 10.1177/0218492311436256
Source: PubMed


An 85-year-old man, who had undergone endovascular abdominal aortic aneurysm repair 8½ years earlier, was transferred to the emergency department with chest pain and transient loss of consciousness. Computed tomography revealed a ruptured abdominal aortic aneurysm with a stent graft inside. His aneurysm was 62 mm in diameter at the endovascular repair, but 45 mm at the rupture site. He was rescued by emergency aneurysmectomy.

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    ABSTRACT: Reduction in aneurysm size during the months after an endovascular graft placement generally is considered one of the criteria of success. We report the case of a patient with an abdominal aortic aneurysm rupture occurring 9 months after a bifurcated endovascular graft placement despite a greater than 45% reduction in size noted on contrast-enhanced computed tomography scan performed at 7 months. Biomaterial modifications of the stent and of the Dacron explanted stent-graft are analyzed. (J Vasc Surg 1998;28:178-83.)
    Journal of Vascular Surgery 08/1998; 28(1):178-83. DOI:10.1016/S0741-5214(98)70213-7 · 3.02 Impact Factor
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    ABSTRACT: We describe a case of abdominal aortic aneurysm (AAA) with rupture 16 months after treatment by an endograft. A 76-year-old patient on Coumadin after aortic valve replacement had initially successful exclusion by stentgraft. There was no evidence of an endoleak seven months after stentgraft repair, although a computed tomography scan detected an enlargement of the aneurysm sac. Sixteen months after initial endograft surgery, rupture of the aneurysm occurred and we performed open emergency surgery. We treated the aneurysm by conventional technique, and the patient survived the rupture. This case emphasized the fact that patients after endograft AAA repair require a close follow-up. An expansion of the aneurysm sac after the procedure should signal failed exclusion, even if a computed tomography scan does not demonstrate an endoleak. Anticoagulation can be an important factor in failure after endoluminal graft treatment. Supravisceral aortic cross clamping is helpful in dealing with a stented aorta.
    Journal of Vascular Surgery 08/1998; 28(1):184-7. DOI:10.1016/S0741-5214(98)70214-9 · 3.02 Impact Factor
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    ABSTRACT: To provide insight into the causes and timing of AAA rupture after EVAR. Original data regarding AAA ruptures following EVAR were collected from MEDLINE and EMBASE databases. Data were extracted systematically and patient and procedural characteristics were analyzed. 270 patients with AAA ruptures after EVAR were identified. Causes of rupture included endoleaks (in 160: type IA 57, type IB 31, type II 23, type III 26, type IV 0, endotension 9, unspecified 14), graft migration 41, graft disconnection 11 and infection 6. Most of the described AAA ruptures occurred within 2-3 years after EVAR. Mean initial AAA diameter was relatively large (65 mm). No abnormalities were present in 41 patients during follow-up before rupture. Structural graft failure was described in 96 and a fatal course in 119 patients. Focus of surveillance on the first 2-3 years after EVAR may possibly reduce the AAA rupture rate, especially in patients with increased risk of early rupture (relatively large initial AAA diameter or presence of endoleak or graft migration). Better stent-graft durability and longevity is required to further reduce the AAA rupture risk after EVAR. Complete prevention will however remain challenging since AAA rupture may occur even if no predisposing abnormalities are present.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 12/2008; 37(1):15-22. DOI:10.1016/j.ejvs.2008.10.011 · 2.49 Impact Factor