Treatment of Abdominal Aortic Endograft Infolding

Martijn Van Dorp,Abraham Rijbroek,Herman Rijna,Wilhelmina Hj Van Vierssen Trip,Erik Gj Vermeulen,Leonard J Van Boven

doi:10.21767/2573-4482.100052

Abstract

Aortic endograft infolding is considered a rare endograft related complication and is mostly reported after deployment in the thoracic aorta. We report a case of early abdominal endograft infolding with luminal obliteration and acute bilateral limb ischemia after endovascular treatment of a common iliac aneurysm. Even though completion Computed Tomography (CT) angiography, three days prior, revealed no apparent mismatch of the stent graft to the aortic wall. This report aims to describe an overview of the different treatment modalities and focuses on the endovascular techniques for inducing re-expansion of the infolded graft and allowing for improved sealing of the endograft.

Highlights

IntroductionThe variety and extent of endograft related complications form the downside of Endovascular Aortic Repair (EVAR), these complications allow for considerable re intervention rates, with a freedom of re intervention of 65% for endovascular repair versus 86% for open repair [1,2]
We present a case of early, symptomatic abdominal endograft infolding in which the patient presented with severe bilateral acute limb ischemia
We were presented with a proximal abdominal endograft collapse after apparently sufficient primary endovascular repair for an iliac aneurysm

Summary

Introduction

The variety and extent of endograft related complications form the downside of Endovascular Aortic Repair (EVAR), these complications allow for considerable re intervention rates, with a freedom of re intervention of 65% for endovascular repair versus 86% for open repair [1,2]. Thereby, the applicability of endovascular repair for abdominal aneurysms with a hostile anatomy could be limited [3]. One of the reported endograft related complications is device infolding, characterized as collapse, and is predominantly described in thoracic aortic endografts [4]. Hereby the endoprosthesis collapses, narrowing or obliterating the lumen of the endograft, with potentially detrimental consequences. We present a case of early, symptomatic abdominal endograft infolding in which the patient presented with severe bilateral acute limb ischemia. The patient underwent an endovascular repair and this report aims to describe the different techniques for the treatment of abdominal aortic endograft infolding

Objectives

Conclusion