Endoleak after an Open Abdominal Aortic Aneurysm Repair

Albert G Hakaim,Charles G Stoneburner,Gregory Frey

doi:10.21767/2573-4482.10003

Abstract

Although endoleaks have been well described after endovascular abdominal aortic aneurysm (AAA) repair, their occurrence after open repair is much less common. This case report describes a patient who had a leak at the proximal anastomotic site of the graft after open AAA repair. The patient was a 78 year old male patient who presented to our facility with bright red blood from the rectum at approximately 3 months after an open AAA repair at an outside facility. On computed tomographic angiography, a leak was detected at the proximal anastomotic site and resembled a type I endoleak that may occur after endovascular repair. The patient was treated through endovascular technique with the placement of two proximal extension cuffs. The endoleak was not observed on follow-up imaging, and the patient has been asymptomatic since treatment. Endoleaks after open AAA repair are rare, but they can be treated through an endovascular approach, with proximal extension cuff placement to seal the leak.

Highlights

Endoleaks occurring after endovascular aortic repair (EVAR) have been well described
Para Anastomotic Aneurysm (PAA) have been well described and may be associated with a leak at the proximal or distal portion of the graft, they are typically seen long after the original repair, usually about 10 years postoperatively [3]. This case report describes a patient who presented from an outside facility and was found to have an endoleak after undergoing open abdominal aortic aneurysm (AAA) repair approximately 3 months prior
PAAs have been associated with endoleaks, an endoleak occurring so close to the postoperative period is less common to observe in a patient who has had open AAA repair

Summary

Introduction

Endoleaks occurring after endovascular aortic repair (EVAR) have been well described. PAAs have been well described and may be associated with a leak at the proximal or distal portion of the graft, they are typically seen long after the original repair, usually about 10 years postoperatively [3] This case report describes a patient who presented from an outside facility and was found to have an endoleak after undergoing open AAA repair approximately 3 months prior. The patient was a 78 year old man with past medical history of AAA status post open repair in August 2014 at an outside facility, long-term lupus anticoagulation treatment with warfarin, pulmonary embolus, and peripheral vascular disease He presented to our facility in November 2014 with severe weakness and stools with bright red blood. The patient reported that he had been doing well and had no recurrence of symptoms

Discussion

Findings

Conclusion