Rupture of abdominal aortic aneurysm previously treated by endovascular stentgraft

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.

MR angiography vs CT angiography in the follow-up of nitinol stent grafts in endoluminally treated aortic aneurysms

“…Stentgraft disconnection, limb retraction, or proximal migration of the stent-graft body (type-1 and type-3 endoleaks, respectively) may result in direct bleeding into the aneurysm sac. An untreated type-1 endoleak results in an increase in the diameter of the aneurysm sac and is associated with an increased risk of aneurysm rupture [4,17,18,19]. In our series type-1/type-3 endoleaks were equally well detected with both CTA and MRA.…”

“…Due to its impressive spatial resolution (in the z-axis) multidetector row CT imaging might be of greater advantage in the detection of small endoleaks, especially in the delayed phase, but its value might still be limited by the low contrast-to-noise ratio of iodinated contrast media, higher contrast media flow rates might be able to address this problem. According to the EUROSTAR registry, the incidence of type-2 endoleaks (reperfusion endoleaks) decreases within the first year of follow-up, but the final consequences of type-2 endoleaks remains to be clarified [4,17,18,19], although presence of type-2 endoleaks does not seem to be associated with an overall increased risk of rupture [18]. Current recommendations from the EUROSTAR registry advise that only the combination of type-2 leak and increased aneurysm diameter might require intervention [18].…”

“…Current recommendations from the EUROSTAR registry advise that only the combination of type-2 leak and increased aneurysm diameter might require intervention [18]. Type-2 endoleaks, particularly those due to a patent inferior mesenteric artery, may be of clinical relevance when high pressure within the aneurysm sac persists over time, which can result in a progressive increase in the aneurysm sac diameter at follow-up [4,17,18,19]. Consequently, one aortic rupture in a patient with a known type-2 endoleak was observed in our series of 189 endoluminally treated abdominal aneurysms (S. Thurnher, pers.…”

Die Aneurysmabehandlung mit dem “Talent-Stentgraft”Eine Bilanz nach 4-jähriger Erfahrung

“…Neben dem technischen Erfolg hat man aber auch bald die Grenzen der neuen Technik erkannt. Endoleaks verschiedener Ursachen [3,12], Gefäßkomplikationen [8] und vereinzelt auch Aneurysmarupturen [9] wurden beschrieben. Prospektiv randomisierte Studien über die Sinnhaftigkeit der neuen im Vergleich mit der klassischen Methode liegen bislang nicht vor, und die Daten vom deutschen und europäischen Register [3,5] sind, was Indikation, technische Durchführung, Prothesentyp und Vollständigkeit angeht, zu heterogen, um eine valide Aussage zu zulassen.…”

Endovaskuläre Aneurysmatherapie - Langzeitergebnisse nach 7 Jahren

“…einzelt beschriebene Aneurysmarupturen trotz vorangegangener endovaskulärer Therapie werden genau darauf zurückgeführt [11,15].…”