Complete Thrombosis Of Aneurysm Research Articles

Otvorena reparacija aneurizme aorte u endovaskularnoj eri

Open repair (OR) of aortic aneurysms is still relatively mutilating and risky in older and high-risk patients. Since the introduction of EVAR, a significantly lower perioperative mortality has been noted. Apart from advantages, endovascular treatment has some disadvantages as well, due to which OR still has a very important role in the endovascular era. In a vast majority of the patients younger than 65, with good overall condition, long life expectancy and favorable anatomy, as well as in patients with hostile aneurysm neck anatomy, heritable connective tissue disorders, complete thrombosis of abdominal aortic aneurysm (AAA) and potent accessory renal arteries, OR is the first treatment option in comparison with the endovascular treatment. EVAR is recommended as the first treatment option in patients with inflammatory aneurysms and OR should be considered only in better shaped patients with inflammatory AAA and significant hydronephrosis. Late open surgical conversion (LOSC) is a noted event after endovascular treatment and is associated with a significantly higher perioperative mortality and other serious perioperative complications compared to primary OR. Multicenter randomized controlled trials (RCT) did not find a significant difference regarding 30-day mortality between open and endovascular repair of ruptured AAA. However, not all ruptured AAA are suitable for endovascular repair. In a hemodynamically unstable patients, when there is no time for MDCT angiography, EVAR is not possible, and OR is the only option. The incidence of abdominal compartment syndrome after OR is significantly lower in comparison with EVAR thanks to surgical evacuation and drainage of retroperitoneal hematoma. The improvement of the results of aortic aneurysm treatment largely depends on the volume of yearly aortic operations. Having in mind all the mentioned advantages and disadvantages of OR and endovascular repair, we can conclude that in high volume centers, younger generations of vascular surgeons should be educated in standard and complex open aortic surgery.

Multilayer bare stent technique in treating intact mycotic suprarenal aortic aneurysm: a case report.

BackgroundInvasive aspergillosis (IA) related mycotic aortic aneurysm is rare in immunocompetent patient. The endovascular therapy remains controversial due to potential risk of graft infection, while the suprarenal cases might face catastrophic complications during open surgery.Case summaryWe presented an IA case with suprarenal abdominal aortic aneurysm confirmed by joint effusion. Multilayer bare stent technique was performed to preserve visceral blood flow and promote aneurysmal thrombus formation, along with antifungal treatment. Two years of follow-up revealed complete aneurysm thrombosis without evidence of infection.DiscussionFungal infection that affects the aorta is difficult to recognize due to often negative blood cultures. Close observation is recommended in case of suspicion of mycotic aneurysms. Multilayer bare stent technique can restore luminal laminar blood flow and reduce the risk of infection in intact mycotic suprarenal aortic aneurysm.

A New Aortic Arch Inclusion Technique with Frozen Elephant Trunk for Aortic Arch Aneurysm Treatment.

Various surgical techniques have been proposed for treating aortic arch aneurysm (AAA); however, the optimal treatment has not been well defined. This study introduces a new aortic arch inclusion technique with frozen elephant trunk (FET) for AAA treatment.A retrospective analysis was performed among 22 patients for AAA surgical treatment between March 2010 and March 2019. Patients were classified into Z1, Z2, and Z3 groups based on the origins of aneurysms. A stent graft with a 10 cm stented graft and 5-9 cm proximal vascular prosthesis was released into the descending thoracic aorta as FET through an incision in the aortic arch. The proximal vascular prosthesis was retracted into the aortic arch, trimmed to expose the orifices of the brachiocephalic vessels, and sutured inside the aortic arch using the inclusion technique. The proximal sealing location of the vascular graft was tailored to cover the origins of aneurysms.There was no 30-day mortality. No patient had postoperative stroke or paraplegia. Complete aneurysm thrombosis was achieved in all patients. One patient died of severe respiratory tract stenosis 3 months postoperatively. All other 21 patients were alive during 53.3 ± 36.5-month follow-up. Computed tomography angiography was obtained in 15 patients during follow-up. Endoleak was observed in one patient, and the other 14 patients were free from aneurysm-related or graft-related complications during follow-up.The aortic arch inclusion technique with FET provides an alternative technique in treating AAA with satisfactory mid-term follow-up results. A larger patient population with long-term follow-up results is warranted.

Complete spontaneous thrombosis of giant upper basilar artery aneurysm: a case report

Complete spontaneous thrombosis of giant upper basilar artery aneurysm: a case report

Early and mid-term results in the endovascular treatment of popliteal aneurysms with the multilayer flow modulator.

Background The endovascular approach became an alternative to open surgical treatment of popliteal artery aneurysm over the last few years. Heparin-bonded stent-grafts have been employed for endovascular popliteal artery aneurysm repair, showing good and stable results. Only few reports about the use of multilayer flow modulator are available in literature, providing small patient series and short follow-up. The aim of this study is to report the outcomes of patients with popliteal artery aneurysm treated with the multilayer flow modulator in three Italian centres. Methods We retrospectively analysed a series of both symptomatic and asymptomatic patients with popliteal artery aneurysm treated with the multilayer flow modulator from 2009 to 2015. Follow-up was undertaken with clinical and contrast-enhanced ultrasound examinations at 1, 6 and 12 months, and yearly thereafter. Computed tomography angiography was performed in selected cases. Primary endpoints were aneurysm sac thrombosis; freedom from sac enlargement and primary, primary-assisted and secondary patency during follow-up. Secondary endpoints were technical success, collateral vessels patency, limb salvage and aneurysm-related complications. Results Twenty-three consecutive patients (19 males, age 72 ± 11) with 25 popliteal artery aneurysms (mean diameter 23 mm ± 1, 3 symptomatic patients) were treated with 40 multilayer flow modulators during the period of the study. Median follow-up was 22.6 ± 16.7 months. Complete aneurysm thrombosis occurred in 92.9% of cases (23/25 cases) at 18 months. Freedom from sac enlargement was 100% (25/25 cases) with 17 cases of aneurysm sac shrinkage (68%). At 1, 6, 12 and 24 months, estimated primary patency was 95.7%, 87.3%, 77% and 70.1%, respectively. At the same intervals, primary-assisted patency was 95.7%, 91.3%, 86% and 86%, respectively, and secondary patency was 100%, 95.7%, 90.3% and 90.3%, respectively. Technical success was 100%. The collateral vessels patency was 72.4%. Limb salvage was 91.4% at 24-month follow-up. One multilayer flow modulator fracture was reported in an asymptomatic patient. Conclusions Multilayer flow modulator seems a feasible and safe solution for endovascular treatment of popliteal artery aneurysms in selected patients.

Case Series on Perforator Aneurysm: Endovascular Stenting—A Safe Strategy

AbstractPerforator aneurysms are rare vascular lesions that are infrequently reported in literature, and because of difficult anatomic approach, their treatment and management pose challenges. Given the rarity of these aneurysms, the natural history and ideal approach to treatment has not been established. The authors retrospectively analyzed six patients, age ranging from 16 to 75 years with ruptured perforator aneurysm, four of posterior circulation and two of anterior circulation including clinical characteristics, imaging data, treatment regimen, and outcome. All but two patients presented with the World Federation of Neurosurgical Societies grades I to III and Fisher grade 2 or 3 subarachnoid hemorrhage, and the other two presented with intracerebral bleed in the right gangliocapsular region. Four patients were managed conservatively whereas two basilar perforator aneurysms were treated with endovascular stent. At the last follow-up, the endovascularly treated group of patients demonstrated complete thrombosis of aneurysm with preservation of perforators, and the conservatively managed group showed spontaneous occlusion in one patient, whereas three were lost to follow-up and ultimate outcome remains unknown. The authors report single-center hospital-based experience in six patients, which adds to the scarce published literature that addresses the limited understanding of the natural course and consolidating safe endovascular management of this entity.

Chronic complete thrombosis of abdominal aortic aneurysm: An unusual presentation of an unusual complication

Although mural thrombosis frequently accompanies aneurysmal disease, complete thrombosis is distinctly unusual complication of abdominal aortic aneurysm (AAA). A case study of a patient with chronic, asymptomatic complete thrombosis of a large juxtarenal AAA is presented along with a literature review and discussion of the potential secondary complications, mandating aggressive management of this condition. A 67-year-old man with multiple atherogenic risk factors and unattended complaints consistent with a recent episode of a transient right hemispheric ischemic attack was referred to our clinic with a diagnosis of a thrombosed AAA established by computed tomography. Duplex ultrasonography and aortography confirmed the referral diagnosis and also revealed near occlusion of the left internal carotid artery. The patient underwent a two-stage surgery, with preliminary left-sided carotid endarterectomy followed three days later by an aneurysmectomy and aortobifemoral reconstruction. He had an uncomplicated recovery and was discharged home on postoperative day 7, remaining asymptomatic at the 42-month follow-up. Complete thrombosis is an uncommon presentation of AAA and may be clinically silent. It is frequently associated with other manifestations of generalized atherosclerosis. Radical open repair yields durable result and is the preferred treatment modality.

Thrombosis and recanalization of a blister-like aneurysm: letter to the editor

Dear Editor, We would like to report the first case of a complete thrombosis and recanalization of a blister-like aneurysm. The partial or complete spontaneous aneurysmal thrombosis is reported by multiple authors and ranges between 13 and 20 % of giant aneurysms [4]. This phenomenon has been exceptionally reported in nongiant aneurysms and has never been documented with a blister-like aneurysm. A 54-year-old man was diagnosed with a subarachnoid hemorrhage (SAH) of Fisher grade III (GCS: 14). Arteriography showed an aneurysm of the left MCA bifurcation. Four days after its complete clipping, the patient deteriorated due to a new SAH. An aneurysm on the left A1 segment was disclosed. The patient died 72 h after this second SAH. The autopsy demonstrated a ruptured blister-like aneurysm of A1, which was probably also responsible for the first SAH (Fig. 1). Blister-like aneurysms account for only 1 % of all intracranial aneurysms [1]. They are characterized by their small size and a broad base. Their very thin wall is associated with growth in short intervals and rapid evolution towards the rupture [2]. The diagnosis of blister-like aneurysms, uneasy to distinguish from normal variants, remains complicated [5]. In our case, the blister-like ICA was not visualized at the first CT angiography. The occurrence of false-negative cerebral angiography in acute non-traumatic SAH is 5 %. The main cause of SAH with negative angiogram is a nonvisualized aneurysm. The incidence of ruptured ICA disclosed at a delayed angiography is about 16 %. Five possible reasons have been reported: inadequate angiography, obliteration of aneurysm by the hemorrhage, aneurysm thrombosis, an aneurysm too small to be visualized, and lack of aneurysm filling due to vasospasm [6]. The hypothesis the most probable is thrombosis of the aneurysm shortly after its rupture preventing its visualization at the first angiography. The spontaneous aneurysmal thrombosis is well known in giant aneurysms [4]. Intrinsic factors influencing its occurrence are the aneurysm morphology (narrow neck), the presence of endothelial lesion and hemodynamic patterns in the parent artery. An extrinsic factor can be the compressive effect exerted by the hematoma around the aneurysm. In many cases, aneurysmal thrombosis has an unfavorable natural evolution with the occurrence of thromboembolic events, recanalization, and bleeding [3]. In non-giant aneurysms, such in blister-like ones, this process is poorly documented and not understood. Such an occurrence seems to be exceptional. We report, for the first time, a complete thrombosis and recanalization of a blister-like aneurysm, disclosed after a D. Tassigny :G. Vaz : C. Raftopoulos (*) Department of Neurosurgery, University Hospital St-Luc, Universite Catholique de Louvain (UCL), Avenue Hippocrate, 10, 1200 Brussels, Belgium e-mail: christian.raftopoulos@uclouvain.be

Endovascular Repair of Peripheral and Visceral Aneurysms With the Cardiatis Multilayer Flow Modulator:One-Year Results From the Italian Multicenter Registry

To assess the efficacy of the Cardiatis multilayer flow modulator (CMFM), a bare cobalt alloy self-expanding stent, in the treatment of peripheral and visceral artery aneurysms. In this multicenter (n=22), prospective, voluntary registry, 54 patients (47 men; mean age 68 years, range 19-87) who underwent CMFM deployment for peripheral (n=35) or visceral aneurysms (n=19) in a variety of target arteries were enrolled between June 2009 and June 2010. Among the 54 lesions, 44 had a total of 53 side branches. The main effectiveness endpoint was stent and side branch patency with no aneurysm rupture or reperfusion at 1, 6, and 12 months after stent implantation. Outcome measures were complete aneurysm thrombosis and sac shrinkage. The safety endpoint was freedom of complications (death, aneurysm rupture, endoleak, need for reintervention, stent foreshortening, stent occlusion, and access-site sequelae). Aneurysms were categorized as saccular (type I) or fusiform (type II) without a side branch or with branch(es) in the sac (subtype A), neck (subtype X), or both (subtype AX). Kaplan-Meier estimates were calculated for primary and secondary endpoints. Sac shrinkage was correlated to aneurysm morphology subtypes and presence/absence of mural thrombus. Technical success was achieved in all patients. Mortality at 1 year was 5.5% (n=3), including 1 perioperative death. Six patients were lost to follow-up. There was no aneurysm rupture. Six (11.1%) stents occluded over the 1-year period; 3 asymptomatic patients were not treated, 2 symptomatic patients had successful stent dilation to restore patency, and 1 symptomatic patient required bypass (the only side branch lost). Cumulative primary and secondary patency estimates were 86.9% and 90.7% at 1 year. The cumulative side branch patency was 96.1% and the freedom from all complications was 83.0% at 1 year. Complete aneurysm thrombosis was recorded in 42 (93.3%) of 45 patients at 1 year. Percent diameter reduction was 15.5%, 3.8%, and 11.0% at 1, 6, and 12 months (p<0.05), respectively. Presence of mural thrombus did not influence the time course of shrinkage (p>0.05), while complex lesion anatomy (presence of side branches) delayed shrinkage (p<0.05). Results at 1 year show that CMFM can be safely used in the treatment of PAA and VAA, with good results in terms of freedom from rupture, patency of the stents and side branches, complete aneurysm thrombosis, shrinkage, and acceptable freedom from morbidity and mortality.

Endovascular Treatment of a Congenital Thoracic Aortic Aneurysm in a Premature Newborn

Congenital aortic aneurysms are a rare, life-threatening disorder that present complex treatment challenges. The authors describe a congenital thoracic aortic aneurysm treated by endovascular means with stent-assisted coil deployment. Because of rapid in utero aneurysm growth and cardiac dysfunction, a 2.6-kg male was delivered expeditiously by Cesarean section at 352/7 weeks' gestation. On day of life 1, bilateral femoral arterial access was used to deliver a balloon-expandable stent across the wide-necked aneurysm. Microcoil embolization of the aneurysm via a prepositioned microcatheter was then performed. The child had an uncomplicated hospital course and is asymptomatic 5 months later, with complete aneurysm thrombosis.

Complete spontaneous thrombosis of a non-giant middle cerebral artery aneurysm: report of two cases

AbstractSpontaneous intra-aneurysmal thrombosis occurs in approximately 50% of giant intracranial aneurysms. The incidence of this process is associated to location, size, and origin, and the natural history of spontaneous thrombosis occurrence in non-giant aneurysms is rare and still unclear. We describe two non-giant middle cerebral artery (MCA) aneurysms that spontaneously thrombosed and comment the aspects of the literature.

Long-term patency of complex bilobular, bisaccular, and broad-neck aneurysms in the rabbit microsurgical venous pouch bifurcation model

Objectives: In experimental aneurysm models, long-term patency without spontaneous thrombosis is the most important precondition for analyses of embolization devices. We recently reported the feasibility of creating complex venous pouch bifurcation aneurysms in the rabbit with low morbidity, low mortality, and high short-term aneurysm patency. In order to further evaluate our model, we examined the long-term patency rate.Methods: Various sizes of complex bilobular, bisaccular, and broad-neck venous pouch aneurysms were surgically formed at an artificially created bifurcation of both common carotid arteries in 17 rabbits. Early aggressive anticoagulation was continued for 1 month. The rabbits were followed up using contrast-enhanced three-dimensional 1·5-T magnetic resonance angiography (CE-3D-MRA) at 1 month and up to 1 year after creation of the bifurcation.Results: At 1-month follow-up, all but one of the created aneurysms and all parent vessels proved to be patent. Three animals (18%) were lost during follow-up for reasons unrelated to aneurysm surgery. At 1-year follow-up, one animal showed partial and one complete spontaneous aneurysm thrombosis (aneurysm patency rate: 86%). Six out of 42 parent vessels were occluded at that time (vessel patency rate: 86%).Conclusions: Complex bilobular, bisaccular, and broad-neck microsurgical aneurysm formation in the rabbit bifurcation model demonstrates a high long-term patency rate but is complicated by high rates of unrelated procedural mortality and morbidity. There is no need for prolonged (>4 weeks) anticoagulation to achieve good long-term patency in complex venous pouch bifurcation aneurysms.

Symptomatic Aneurysm of a Perforating Peroneal Artery After a Blunt Trauma

A 48-year-old woman was referred to us for a pulsatile and painful mass on the right leg after a trauma occurred 2 months earlier. The duplex scan revealed the presence of an aneurysm of the perforating peroneal artery. The patient underwent an endovascular coil embolization of the aneurysm. The duplex-scan follow-up showed the patency of the peroneal vessel and the complete aneurysm thrombosis. The patient was discharged in good condition without pain. In literature, only four cases of aneurysm of perforating peroneal artery aneurysm, all with a clear traumatic etiology, are reported. In this case, the endovascular treatment was safe and effective.

Complete abdominal aortic aneurysm thrombosis and obstruction of both common iliac arteries with intrathrombotic pressures demonstrating a continuing risk of rupture: a case report and review of the literature

IntroductionAlthough mural thrombus in an abdominal aortic aneurysm is frequent and its role has been studied extensively, complete thrombosis of an abdominal aneurysm is extremely rare and its natural history in relation to the risk of rupture is not known. The case of a patient with a completely thrombosed infrarenal aneurysm is presented along with a literature review.Case presentationWe report the case of a 56-year-old Caucasian man with an infrarenal abdominal aortic aneurysm, presenting at our hospital due to critical ischemia of his right lower limb. Computed tomography and angiography demonstrated complete aneurysm thrombosis and obstruction of both common iliac arteries.ConclusionDuring the operation, systolic and mean intrathrombotic pressures, measured in different levels, constituted 74.5-90.2% and 77.5-92.5% of systolic and mean intraluminal pressure and 73-88.4% and 76.5-91.3% of systemic pressure, respectively. Our findings show that there may be a continuing risk of rupture in cases of a thrombosed abdominal aortic aneurysm.

Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients

We studied the long-term outcome of arch aneurysm repair with a long elephant trunk (LET) anastomosed at the base of brachiocephalic artery. Between 1998 and 2008, 111 patients underwent arch aneurysm repair with LET. A 4-branched graft was sutured to the sinotubular junction, the distal ascending aorta transected, and a LET inserted into the aortic arch while selective cerebral perfusion was maintained. The graft distal end was anastomosed to the LET, incorporating the distal ascending aorta, and arch vessels were anastomosed to graft branches. Concomitantly, 33 patients (30%) underwent other cardiac procedures, including 11 aortic root replacements. Two patients died (1.8%) within 30 days and 7 died (6.3%) after 30 days. Perioperative morbidity included 2 (1.8%) with stroke, 3 (2.7%) with paraplegia, and 1 (0.9%) with paraparesis. Postoperative computed tomography scans revealed complete aneurysmal thrombosis around the LET in 88 patients (79%), who were monitored without a second-stage procedure. Among 23 patients with incomplete thrombosis, 19 underwent a second-stage procedure to complete distal fixation of the LET. Overall survival was 88%, 83%, and 75%, at 1, 3, and 5 years after aneurysm repair with the LET. No aneurysm rupture or reexpansion occurred in patients with complete thrombosis. Four patients with incomplete thrombosis died of rupture before the second-stage procedure. Our results demonstrated safety and good durability of the LET technique and suggest that this technique is a simple and safe procedure that is applicable to a variety of arch aneurysms.

LEO Stent Monotherapy for the Endovascular Reconstruction of Fusiform Aneurysms of the Middle Cerebral Artery

We present the case of a patient with a fusiform aneurysm of the M1 segment of the middle cerebral artery (MCA) in which endovascular stent placement without coiling was performed. A 3.5-mm x 25-mm LEO self-expanding stent was deployed along the fusiform aneurysm of the horizontal MCA M1 segment. Digital subtraction angiography showed progressive thrombosis at 6 months and complete thrombosis of the fusiform MCA aneurysm at 12 months.

QUANTIFICATION OF HEMODYNAMIC CHANGES INDUCED BY VIRTUAL PLACEMENT OF MULTIPLE STENTS ACROSS A WIDE-NECKED BASILAR TRUNK ANEURYSM

The porous intravascular stents that are currently available may not cause complete aneurysm thrombosis and may therefore fail to provide durable protection against aneurysm rupture when used as a sole treatment modality. The goal of this study was to quantify the effects of porous stents on aneurysm hemodynamics using computational fluid dynamics. The geometry of a wide-necked saccular basilar trunk aneurysm was reconstructed from a patient's computed tomographic angiography images. Three commercial stents (Neuroform2; Boston Scientific/Target, San Leandro, CA; Wingspan; Boston Scientific, Fremont, CA; and Vision; Guidant Corp., Santa Clara, CA) were modeled. Various combinations of one to three stents were virtually conformed to fit into the vessel lumen and placed across the aneurysm orifice. An unstented aneurysm served as a control. Computational fluid dynamics analysis was performed to calculate the hemodynamic parameters considered important in aneurysm pathogenesis and thrombosis for each of the models. The complex flow pattern observed in the unstented aneurysm was suppressed by stenting. Stent placement lowered the wall shear stress in the aneurysm, and this effect was increased by additional stent deployment. Turnover time was moderately increased after single- and double-stent placement and markedly increased after three stents were placed. The influence of stent design on hemodynamic parameters was more significant in double-stented models than in other models. Aneurysm hemodynamic parameters were significantly modified by placement of multiple stents. Because the associated modifications may be helpful as well as harmful in terms of rupture risk, use of this technique requires careful consideration.

Single-stage repair of arch aneurysms with a long elephant trunk: Medium-term follow-up of thromboexcluded aneurysms

The purpose of this study was to investigate the medium-term results of arch aneurysms repaired by total arch replacement with a long elephant trunk and to evaluate whether this technique requires a subsequent distal anastomosis at the descending aorta when complete aneurysmal thrombosis is achieved around a long elephant trunk. From June 1999 through May 2005, 32 consecutive patients with arch aneurysms underwent total arch replacement with a long elephant trunk anastomosed at the base of the innominate artery. Postoperatively, aneurysm size was evaluated by means of serial computed tomographic scanning. None of the patients experienced a new stroke, although there was 1 (3%) hospital mortality. Computed tomographic scanning demonstrated complete thrombosis of the aneurysm in 29 (91%) patients within 1 month after surgical intervention, and 3 patients with incomplete thrombosis of the aneurysm underwent a subsequent distal anastomosis in the descending aorta. The 3-year survival rate was 87%, with no aneurysm rupture or sudden death. In the 29 patients who showed complete thrombosis of the aneurysm surrounding a long elephant trunk, serial computed tomographic scanning revealed a significant reduction in the size of the thrombosed aneurysm (81% at 1 year and 76% at 2 years after surgical intervention), and there was no case that showed expansion of the aneurysm. Arch aneurysms were repaired safely by means of total arch replacement with a long elephant trunk, and successful shrinkage of the arch aneurysm suggests that this technique does not require subsequent distal anastomosis and could turn the 2-stage elephant trunk procedure into a single-stage repair when complete aneurysmal thrombosis is achieved.

Embolization of Isolated Hypogastric Artery Aneurysm: A Case Report and a Review of the Literature

A 75-year-old man with arterial hypertension, coronary artery disease, and myocardial infarction was referred to our service because of an asymptomatic hypogastric artery aneurysm (HAA) detected by a routine computed tomography (CT) scan. As shown on the angio-CT the maximum transverse diameter (m.t.d.) of the HAA was 47 mm. There were no symptoms of distal embolization or compression on the pelvic structures. We performed the successful complete thrombosis of the aneurysm using vascular plugs via a controlateral femoral approach. The control angiogram was satisfactory and there were no intraoperative complications. A CT-angiography done 4 months after the procedure showed no signs of refilling of the aneurysm sac. This case illustrates some possible advantages of vascular plugs in the treatment of isolated HAA.

Regarding “Axillobifemoral bypass and aortic embolization for the treatment of two patients with ruptured infrarenal aortic aneurysms”: Complete thrombosis of aneurysm prevents rupture?

We read with interest the case report by Coleman et al (J Vasc Surg 2005;41:340-7) of axillobifemoral bypass and aortic embolization for the treatment of two patients with ruptured infrarenal aortic aneurysms who experienced excellent 10-months outcomes. This nonresectional therapy is based upon a hypothesis that complete thrombosis of an aneurysm might prevent rupture.