Endovascular treatment of a triple paraanastomotic aneurysm after aortobiiliac reconstruction

Abstract

We report a case of a 72-year-old patient considered unfit for open surgery, presenting with paraanastomotic aneurysms of all three anastomoses, 13 years after an open aortobiiliac reconstruction for abdominal aortic aneurysm. This patient was successfully treated with an endovascular approach using a left aortouniiliac endograft and a right iliac tubular endograft, followed by crossover femorofemoral bypass. This report illustrates the usefulness of a minimally invasive approach for solving this complication of aortic open surgery and discusses technical issues related to endovascular devices in this particular setting.Keywords: Pseudoaneurysm, aortic and iliac surgery, endovascular repair, endovascular treatment, anastomosis, postoperative complications. ResumoRelatamos um caso de um paciente de 72 anos não considerado elegível para cirurgia aberta, apresentando aneurismas para-anastomóticos das três anastomoses, 13 anos após uma reconstrução aberta aorto-biilíaca para aneurisma aórtico abdominal. Este paciente foi tratado com sucesso através de abordagem endovascular usando uma endoprótese aorto-uniilíaca esquerda e uma endoprótese tubular ilíaca direita, seguida por derivação cruzada fêmoro-femoral. Este relato ilustra a utilidade de uma abordagem minimamente invasiva para o tratamento desta complicação da cirurgia aórtica aberta e discute questões técnicas relacionadas a dispositivos endovasculares neste contexto em especial. Palavras-chave:Pseudo-aneurisma, cirurgia ilíaca e aórtica, reparo endovascular, tratamento endovascular, anastomose, complicações pós-operatórias.

Surgical perspective in pseudoaneurysm of peripheral arteries: a better limb salvage option

“…Complications include covered stent migration, persistent leakage of blood into the pseudoaneurysm, fracturing (breaking) of the stent, and infection of the stent or of the arterial insertion site. 1,2 Under ultrasound guidance, thrombin can be injected directly into a pseudoaneurysm, causing it to clot. Advantages are that the technique is relatively easy to perform, is successful, and is minimally invasive.…”

Man with a Forehead Mass: Detection of a Forehead Pseudoaneurysm with Bedside Ultrasonography

“…This is a minimally invasive technique that has a high success rate and can be performed by an interventional radiologist or vascular surgeon without the need for an open surgery [ 3 ]. Complications of this procedure include stent migration, persistent leakage of blood into the pseudoaneurysm, and infection [ 17 , 18 ]. Ultrasound-guided thrombin injection is another proposed treatment of pseudoaneurysms, whereby thrombin is directly injected into the pseudoaneurysm allowing it to clot [ 19 ].…”