Endovascular treatment of endotension with dacron stent graft reinforcement and femorofemoral crossover bypass: therapeutic challenge

Abstract

A 54 year-old man with an asymptomatic 5.9 cm AAA was treated with an Excluder® 26 mm/14.5 mm/16 cm endoprosthesis (Gore, USA). Initial aortic morphology showed a proximal neck of 2.0 cm of extension by 23 mm of diameter. The common iliac arteries measured 13 mm in right diameter and 12 mm in left diameter. No endoleak was detected immediately after the procedure. One month after the procedure, computed tomography (CT) scan showed maintenance of aneurysmal diameters without evidence of endoleak (Figure 1). After one year, follow-up duplex ultrasound and CT scan showed no endoleak, but a small growth of the aneurysmal sac to 6.2 cm was observed (Figure 2). Aortography with selective visceral and hypogastric arteries showed no endoleak (Figure 3). We decided to observe the outcome of the condition with a second CT scan within six months. The patient only returned after one year, when CT scan found the aneurysmal diameter had increased to 7.5 cm, but without evidence of endoleak. The case was interpreted as endotension, and intervention was considered. Since the patient presented class II heart failure, poorly controlled cardiac arrhythmia and a previous left pneumonectomy for a neoplasm, an endovascular approach was chosen.