Testicular infarction: A rare complication of endovascular aneurysm repair treatment for aortoiliac aneurysm

Abstract

Endovascular aneurysm repair (EVAR) is an established therapy to prevent rupture in large infrarenal abdominal aortic aneurysms (AAA). As experience with this therapy has grown, treatment of more challenging anatomy has led to the identification of several new procedurally related complications. We report the case of a 67-year-old man with an asymptomatic, large infrarenal AAA with an associated left common iliac artery aneurysm. Endovascular therapy for an aortoiliac aneurysm involved prior coil embolization of his left internal iliac artery to allow conventional EVAR with extension to the external iliac artery of the left graft limb, thus excluding the left iliac aneurysm. He presented 6 weeks postoperatively with onset of left-sided scrotal pain and underwent emergency orchidectomy for ischemic infarction of his left testis. The histology report confirmed that the left testis was necrotic secondary to a thrombus in the testicular artery. To our knowledge, this is the first report of testicular infarction after EVAR.

Acute Testicular Ischemia following Endovascular Abdominal Aortic Aneurysm Repair Identified in the Emergency Department

“…In a case report by McKenna et al, a man of similar age presented with acute onset left scrotal pain following EVAR [6]. One notable difference for McKenna et al was that the patient presented 6 weeks after operation and had undergone CTA surveillance at 4-week follow-up, as opposed to 2 days after procedure reported here.…”

“…Additional complications include stent migration, aneurysm sac expansion, stent occlusion, and delayed rupture [1, 6]. Ischemic complications following EVAR are uncommon but have included acute limb ischemia due to stent graft limb occlusion as well as colon and bladder ischemia [6–10]. Thromboembolic events are also rare but have been reported in association with both EVAR and OSR [2, 3, 6].…”

“…McKenna et al [6] report thrombus as the inciting event; Hall et al [7] consider the absence of adequate collateral blood flow, delayed occlusion of collaterals, and progressive thrombosis of the aneurismal sac. In reviewing current literature, we add that graft migration and thromboembolism are also potential explanations of the case presented [2, 3, 8–10].…”

A Case of Orchiectomy after Femoral Artery PTA

“…Testicular ischemia is a rarely complication with only four cases till now reported in the literature [3][4][5][6]. After lowerlimb peripheral PTA, the ischemic complications range from intermittent claudication to ischemic necrosis requiring re-PTA, or surgical bypass, or amputation.…”

“…However, the testicular infarction caused by extrinsic compression is a very rare complication of percutaneous procedures. In literature, only four cases of testicular ischemic necrosis are described [3][4][5][6], but a giant hematoma with serious stuffing of the spermatic cord and the testis has been never reported.…”