Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Abstract

We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.Keywords: abdominal aortic endograft, total occlusion, axillobifemoral bypass life-threatening disease associated with high morbidity and mortality. Here we report a case of abdominal aortic endograft total occlusion that was successfully managed with axillobifemoral bypass; in addition, we discuss the treatment strategies for this critical situation. Case ReportA 72-year-old man was admitted to an emergency department of a district hospital, complaining of sudden bilateral lower extremity numbness and severe rest pain. At the age of 62, he had undergone mechanical valve replacement for aortic valve stenosis and permanent pacemaker insertion for sick sinus syndrome at the same hospital. Sixteen months ago, he had undergone abdominal aortic endograft implantation for infrarenal abdominal aortic aneurysm at a different hospital. Preoperative computed tomography (CT) showed the maximum aneurysm diameter of 62 mm, the neck angulation 10) of 77°, and the terminal aorta diameter of 21 mm (Fig. 1). A Zenith endovascular graft (Cook Inc., Bloomington, Indiana) was implanted through the right femoral approach. The procedure was performed successfully and the postoperative course was uneventful. A postoperative CT showed the neck angulation of 56° and the terminal aorta diameter of 21 mm (Fig. 1). The patient was discharged from the hospital with no endoleak. Subsequently, he had been regularly followed-up for anticoagulation therapy at a local hospital. He had not experienced intermittent claudication previously.On further examination at the district hospital, a CT showed an abdominal endograft implanted from below the orifice of the renal arteries to the bilateral common iliac arteries with complete occlusion at the mid-portion of the main body (Fig. 2). The neck angulation was 54°, and the terminal aorta diameter of 21 mm (Fig. 2). Preoperative echocardiography showed that there was no obvious thrombus in the left atrium and the left ventricle, and around the mechanical aortic valve. A diagnosis of acute endograft occlusion was made. The patient was transferred to our hospital 4 h after the onset of symptoms for

Spontaneous recanalization of a total occlusion of an infrarenal abdominal aorta after left axillary-bifemoral bypass

“…1 Causes of aortic occlusions are embolic vs thrombotic, including saddle emboli to the aortic bifurcation, thrombosis of an atherosclerotic aorta, occlusion of an aortic aneurysm, and occlusion of an abdominal aortic endograft. [2][3][4] Spontaneous recanalization of total aortic occlusions has been rarely reported, only previously witnessed in the case of an occlusion secondary to type B dissection and in the resolution of an intramural hematoma (IMH) after axillary-bifemoral bypass. 5,6 We describe a case of a total occlusion of an infrarenal abdominal aorta, of indeterminate etiology, managed with a left axillary-bifemoral bypass and left femoral-popliteal Fogarty thrombectomy.…”