Abdominal Aortic Repair and Inferior Vena Cava Interposition in a Patient with Ruptured Aneurysm

Introduction

We report a case of a ruptured abdominal aortic aneurysm (RAAA) with atypical localisation of inferior vena cava (IVC), successfully managed with open surgery repair.

Case Report

A 52-year-old male patient presented with a 2-day duration of acute abdominal pain and acute left limb pain. Computed tomographic angiography demonstrated ruptured abdominal aortic aneurysm with massive retroperitoneal haematoma and occluded left superficial femoral artery. In addition, left-sided infrarenal IVC, ventrally crossing the aneurysmal neck, supposed difficult clamping and anastomosing. After transection of IVC, the AAA was successfully repaired with tube graft interposition. Subsequently, IVC was reconstructed with a short 20-mm Dacron graft. The patient had an uneventful recovery.

Conclusion

The case demonstrates the importance of pre-operative imaging for successful treatment of RAAA in the presence of a challenging venous anomaly and one technical decision for this type of cases.