Skip to main content
SpringerLink
Log in

Percutaneous Treatment of Sac Rupture in Abdominal Aortic Aneurysms Previously Excluded with Endovascular Repair (EVAR)

  • Case Report
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study was to assess the feasibility and effectiveness of percutaneous endovascular repair of ruptured abdominal aortic aneurysms (AAAs) previously treated by EVAR. In the last year, two male patients with AAAs, treated 8 and 23 months ago with bifurcated stent-graft, were observed because of lumbar pain and hemorragic shock. Multidetector computed tomography (MDCT) showed a retroperitoneal hematoma; in both cases a type III endoleak was detected, in one case associated with a type II endoleak from the iliolumbar artery. The procedures were performed in the theater, in emergency. Type II endoleak was treated with transcatheter superselective glue injection; type III endoleaks were excluded by a stent-graft extension. The procedures were successful in both patients, with immediate hemodynamic stabilization. MDCT after the procedure showed complete exclusion of the aneurysms. In conclusion, endovascular treatment is a safe and feasible option for the treatment of ruptured AAAs previously treated by EVAR; this approach allows avoidance of surgical conversion, which is technical very challenging, with a high morbidity and mortality rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. van Marrewijk CJ, Fransen G, Laheij RJ et al (2004) EUROSTAR Collaborators. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg 27(2):128–137

    Article  PubMed  Google Scholar 

  2. Carrafiello G, Lagana D, Recaldini C et al (2006) Comparison of contrast-enhanced ultrasound and computed tomography in classifying endoleaks after endovascular treatment of abdominal aorta aneurysms: preliminary experience. Cardiovasc Intervent Radiol 29:969–974

    Article  PubMed  Google Scholar 

  3. Rozenblit AM, Patlas M, Rosenbaum AT et al (2003) Detection of endoleaks after endovascular repair of abdominal aortic aneurysm: value of unenhanced and delayed helical CT acquisitions. Radiology 227:426–433

    Article  PubMed  Google Scholar 

  4. Torsello G, Osada N, Florek HJ et al (2006) Talent AAA Retrospective Longterm Study Group. Long-term outcome after Talent endograft implantation for aneurysms of the abdominal aorta: a multicenter retrospective study. J Vasc Surg 43:277–284

    Article  PubMed  Google Scholar 

  5. van Marrewijk CJ, Leurs LJ, Vallabhaneni SR et al (2005) Risk-adjusted outcome analysis of endovascular abdominal aortic aneurysm repair in a large population: how do stent-grafts compare? J Endovasc Ther 12:417–429

    Article  PubMed  Google Scholar 

  6. Silverberg D, Baril DT, Ellozy SH et al (2006) An 8-year experience with type II endoleaks: natural history suggests selective intervention is a safe approach. J Vasc Surg 44(3):453–459

    Article  PubMed  Google Scholar 

  7. van Marrewijk C, Buth J, Harris PL et al (2002) Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: the EUROSTAR experience. J Vasc Surg 35(3):461–473

    Article  PubMed  Google Scholar 

  8. Hinchliffe RJ, Singh-Ranger R, Davidson IR et al (2001) Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur J Vasc Endovasc Surg 22(6):563–563

    Article  PubMed  CAS  Google Scholar 

  9. Kubin K, Sodeck GH, Teufelsbauer H et al (2008) Endovascular therapy of ruptured abdominal aortic aneurysm: mid- and long-term results. CardioVasc Interv Radiol [Epub ahead of print]. Available at: http://www.springerlink.com/content/y8tr681001121302/fulltext.html

  10. White R, Donayre C, Walot I et al (2000) Abdominal aortic aneurysm rupture following endoluminal graft development: report of a predictable event. J Endovasc Ther 7:257–262

    Article  PubMed  CAS  Google Scholar 

  11. Harris PL, Vallabhaneni SR, Desgranges P et al (2000) Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. J Vasc Surg 32:739–749

    Article  PubMed  CAS  Google Scholar 

  12. Peppelenbosch N, Buth J, Harris PL et al (2004) Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: does size matter? A report from EUROSTAR. J Vasc Surg 39(2):288–297

    Article  PubMed  Google Scholar 

  13. Torsello GB, Klenk E, Kasprzak B et al (1998) Rupture of abdominal aortic aneurysm previously treated by endovascular stentgraft. J Vasc Surg 28(1):184–187

    Article  PubMed  CAS  Google Scholar 

  14. Parodi JC, Palmaz JC, Barone BD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysm. Ann Vasc Surg 5:491–499

    Article  PubMed  CAS  Google Scholar 

  15. Umscheid T, Stelter WJ (1999) Time-related alterations in shape, position, and structure of self-expanding, modular aortic stent-grafts: a 4-year single-center follow-up. J Endovasc Surg 6:17–32

    Article  PubMed  CAS  Google Scholar 

  16. Baum RA, Carpenter JP, Cope C et al (2001) Aneurysm sac pressure measurements after endovascular repair of abdominal aortic aneurysms. J Vasc Surg 33:32–41

    Article  PubMed  CAS  Google Scholar 

  17. Dias NV, Ivancev K, Malina M, Resch T, Lindblad B, Sonesson B (2004) Intra-aneurysm sac pressure measurements after endovascular aneurysm repair: differences between shrinking, unchanged, and expanding aneurysms with and without endoleaks. J Vasc Surg 396:1229–35

    Article  Google Scholar 

  18. Steinmetz E, Rubin BG, Sanchez LA et al (2004) Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J Vasc Surg 39(2):306–313

    Article  PubMed  Google Scholar 

  19. Parent FN, Meier GH, Godziachvili V et al (2002) The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Surg 35:474–481

    Article  PubMed  Google Scholar 

  20. Ryu RK, Palestrant S, Ryu J, Trachtenberg J (2007) Sac hygroma after endovascular abdominal aortic aneurysm repair: successful treatment with endograft relining. CardioVasc Interv Radiol 30:488–490

    Article  Google Scholar 

  21. Bargellini I, Cioni R, Petruzzi P et al (2005) Endovascular repair of abdominal aortic aneurysms: analysis of aneurysm volumetric changes at mid-term follow-up. CardioVasc Interv Radiol 28:426–433

    Article  Google Scholar 

  22. Springer F, Günther RW, Schmitz-Rode T (2007) Aneurysm sac pressure measurement with minimally invasive implantable pressure sensors: an alternative to current surveillance regimes after EVAR? CardioVasc Interv Radiol [Epub ahead of print]. Available at: http://www.springerlink.com/content/c76583613773x58g/fulltext.html

  23. Malagari K, Brountzos E, Gougoulakis A et al (2004) Large diameter limbs for dilated common iliac arteries in endovascular aneurysm repair: is it safe? CardioVasc Interv Radiol 27:237–242

    Article  Google Scholar 

  24. Bharwani N, Raja J, Choke et al (2008) Is internal iliac artery embolization essential prior to endovascular repair of aortoiliac aneurysms? CardioVasc Interv Radiol [Epub ahead of print]. Available at: http://www.springerlink.com/content/k47817400q520042/fulltext.html

  25. Bratby MJ, Munneke GM, Belli AM et al (2007) How safe is bilateral internal iliac artery embolization prior to EVAR? CardioVasc Interv Radiol [Epub ahead of print]. Available at: http://www.springerlink.com/content/u7j6450783825486/fulltext.html

  26. Alimi YS, Chakfe N, Rivoal E et al (1998) Rupture of an abdominal aortic aneurysm after endovascular graft placement and aneurysm size reduction. J Vasc Surg 28(1):178–183

    Article  PubMed  CAS  Google Scholar 

  27. May J, White GH, Waugh R et al (1999) Rupture of abdominal aortic aneurysms: a concurrent comparison of outcome of those occurring after endoluminal repair versus those occurring de novo. Eur J Vasc Endovasc Surg 18:344–348

    Article  PubMed  CAS  Google Scholar 

  28. Lumsden AB, Allen RC, Chaikof EL et al (1995) Delayed rupture of aortic aneurysms following endovascular stent grafting. Am J Surg 170:174–178

    Article  PubMed  CAS  Google Scholar 

  29. Gawenda M, Krueger K, Brunkwall J (2003) Endotension leading to aneurysm sac rupture following open repair of abdominal aortic aneurysm. Vasa 32(3):169–172

    Article  PubMed  CAS  Google Scholar 

  30. Politz JK, Newman VS, Stewart MT (2000) Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases. J Vasc Surg 31(3):599–606

    Article  PubMed  CAS  Google Scholar 

  31. Hobo R, Buth J, EUROSTAR collaborators (2006) Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report. J Vasc Surg 43(5):896–902

    Article  Google Scholar 

  32. Laganà D, Carrafiello G, Mangini M et al (2006) Emergency endovascular treatment of abdominal aortic aneurysms: feasibility and results. CardioVasc Interv Radiol 29:241–248

    Article  Google Scholar 

  33. Veith FJ, Ohki T, Lipsitz EC et al (2003) Endovascular grafts and other catheter-directed techniques in the management of ruptured abdominal aortic aneurysms. Semin Vasc Surg 16:326–331

    Article  PubMed  Google Scholar 

  34. Halak M, McDonnell CO (2006) Rupture of an abdominal aortic aneurysm previously repaired with an endovascular stent-graft: successful management using an endovascular approach. Isr Med Assoc J 8(3):221–222

    PubMed  Google Scholar 

  35. Faries PL, Cadot H, Agarwal G et al (2003) Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion. J Vasc Surg 37:1155–1161

    Article  PubMed  Google Scholar 

  36. Kasirajan K, Matteson B, Marek JM et al (2003) Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak. J Vasc Surg 38(1):61–66

    Article  PubMed  Google Scholar 

  37. Stavropoulos SW, Kim H, Clark TW et al (2005) Embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms with use of cyanoacrylate with or without coils. J Vasc Interv Radiol 16:857–861

    PubMed  Google Scholar 

  38. Mansueto G, Cenzi D, D’Onofrio M et al (2005) Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: transcaval approach. CardioVasc Interv Radiol 28:641–645

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri, 21100, Varese, Italy

    Domenico Laganà, Monica Mangini, Federico Fontana, Paolo Nicotera, Gianpaolo Carrafiello & Carlo Fugazzola

Authors
  1. Domenico Laganà
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Monica Mangini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federico Fontana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paolo Nicotera
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianpaolo Carrafiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlo Fugazzola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Domenico Laganà.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laganà, D., Mangini, M., Fontana, F. et al. Percutaneous Treatment of Sac Rupture in Abdominal Aortic Aneurysms Previously Excluded with Endovascular Repair (EVAR). Cardiovasc Intervent Radiol 32, 178–183 (2009). https://doi.org/10.1007/s00270-008-9358-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-008-9358-9

Keywords

Search

Navigation