Late Open Conversion with Graft Replacement after Endovascular Aortic Repair along with Removal of a Giant Ovarian Tumor: A Case Report.

Abstract

Introduction: There are many reports of late open conversion after endovascular aortic repair (EVAR). Herein, we report the case of an octogenarian patient with a giant ovarian tumor who underwent ovarian tumor resection and open conversion with graft replacement simultaneously via laparotomy.

Case presentation: An 86-year-old woman underwent EVAR 7 years ago. After surgery, persistent type II endoleaks from the lumbar arteries were detected. The diameter of the aneurysmal sac gradually increased. Although we attempted to perform coil embolization of the lumbar arteries one year ago, the procedure was unsuccessful, and type II endoleaks persisted, further dilating the aneurysmal sac. One month earlier, the patient experienced lower abdominal pain, which was thought to be a symptom of an ovarian tumor. Surgery to remove the ovarian tumor was considered. Although open conversion was considered, laparotomy was difficult due to the presence of the giant ovarian tumor. Therefore, we decided to perform open conversion with aortic graft replacement in addition to salpingo-oophorectomy. Surgery was performed via a median laparotomy, and graft replacement of the infrarenal abdominal aortic aneurysm was performed after salpingo-oophorectomy. The postoperative course of the patient was uneventful, and she was discharged.

Conclusions: We performed a salpingo-oophorectomy and late open conversion with graft replacement after EVAR in an octogenarian patient with a giant ovarian tumor and achieved favorable results.