A Case Report on a Successful Treatment of Late Abdominal Aortic Aneurysm Rupture after Endovascular Repair

Endovascular repair of abdominal aortic aneurysm (EVAR) is currently indicated for most patients with abdominal aortic aneurysm (AAA). Complications that appear within the follow-up period may require quick endovascular or surgical intervention. Untreated type I and III endoleaks may cause aneurysmal sac enlargement and aneurysm rupture. This case report presents the technical aspects of an emergent operation for post-EVAR rupture of AAA in an elderly male patient who was admitted to the hospital due to a hypovolemic shock. The emergent tomographic scan revealed a massive type Ia endoleak and retroperitoneal hematoma. The constant decrease in the patient’s blood pressure required traditional operation. After clamping of the abdominal aorta, the proximal part of the stent graft was extracted from the infrarenal aorta and shortened by 5 cm. This maneuver allowed the interposition of a tube graft between the infrarenal aorta and remaining part of the stent graft. This technique is commonly used for the primary operation of AAA; however, some issues may arise when it is performed after stent grafting. A thin-walled stent graft is out of proportion to the thick-walled Dacron prosthesis and may easily be damaged by the surgical suture. Our case proves that it was possible to bevel the body of the stent graft despite its metal parts; moreover, a special technique of applying the sutures between the prosthesis and the stent graft stump resulted in a good anastomosis and satisfactory final outcome. Cardiology Research and Cardiovascular Medicine Brzezinski T, et al. Cardiolog Res Cardiovasc Med 6: 10169. www.doi.org/10.29011/2638-003X.100069 www.gavinpublishers.com