Rupture Of Infrarenal Aortic Aneurysm Research Articles

Clinical Presentation, Operative Management, and Long-Term Outcome of Rupture After Previous Abdominal Aortic Aneurysm Repair

Late abdominal aortic aneurysm rupture (LAR) after open or endovascular repair is uncommon but life-threatening. In the present study, we characterized the presentation trends, intervention, and survival after LAR. We performed a single-center, retrospective study of patients who had undergone LAR repair from 2000 to 2020. The endpoints were 30-day mortality, major postoperative complications, and survival. We compared the outcomes between LAR managed with endovascular aortic aneurysm repair (EVAR; group I) vs open surgical repair (OSR; group II). Of 390 patients with infrarenal aortic aneurysm rupture, 40 (10%) had undergone prior aortic repair and comprised the LAR cohort (34 men; mean age, 78 years; initial EVAR for 29; initial OSR for 11). LAR had occurred despite reintervention in 13 patients (44%). Endoleaks had developed in 26 patients and were type I in 21 patients (72%), type III in 3 patients, (10%) and type II in 2 patients (3%). Ten patients (29%) were lost to follow-up. LAR after prior OSR was secondary to ruptured para-anastomotic pseudoaneurysms, which were managed with endovascular salvage in nine patients. The time to LAR was shorter after prior EVAR compared with after OSR (6 ± 4 vs 12 ± 4 years, respectively; P = .003). Treatment of LAR was EVAR for 27 patients (67%; group I) and OSR for 14 (35%; group II). EVAR was more frequent in the latter one half of the study period (Fig). In group I, fenestrated repair had been used for seven patients (26%). Salvage for the rest was feasible with EVAR, aortic cuffs, or limb extensions. The incidence of free rupture, time to treatment, 30-day mortality, and disposition was similar between the two groups. Those in group I had had less blood loss (660 vs 3000 mL; P < .001) and need for dialysis (0% vs 33%; P < .001) than those in group II. The median follow-up was 20 months (interquartile range, 6-45 months). The 1-, 3-, and 5-year survival was 76%, 52%, and 41%, respectively, and was similar between the two groups (28 vs 22 months; P = .92). LAR after abdominal aortic aneurysm repair has become increasingly common, likely resulting from the frequency of EVAR. Most LARs, including those occurring after previous OSR, can be now be salvaged with endovascular techniques with lower morbidity and mortality.

Endovascular Y-stent Graft Repair of Chronic Contained Ruptured Abdominal Aortic Aneurysm in High-Surgical Risk Patient

Abdominal aortic aneurysm is a common condition and many a times asymptomatic. The mortality rate is high when it presents with rupture. However, a chronic contained rupture may remain undiagnosed for several weeks to months due to highly variable clinical presentation. Delay in the diagnosis and thereby delay in the treatment lead to worse clinical outcomes in patient experienced chronic contained rupture. We are here presenting a case of an adult patient who experienced rupture of infrarenal aortic aneurysm along with retroperitoneal hematoma. The abdominal aortic aneurysm was diagnosed after several months of rupture as the rupture occurred into the retroperitoneal cavity and remained confined in the retroperitoneal cavity. We successfully treated the patient by deploying a stent percutaneously.

A Spinal Osteophyte as Indication for Treatment of an Infra-renal Aortic Aneurysm

Infra-renal aortic aneurysm rupture is a feared condition, therefore is it important to preview potential factors that could lead to it. A 59-year-old male with ankylosing spondylitis presented with a 4.6 cm diameter infra-renal aortic aneurysm. He had an osteophyte like a harpoon of the third and fourth lumbar vertebra, contacting directly with the aneurysm wall. The patient was submitted to an endovascular procedure. Surgical treatment was mandatory because of the potential high risk of rupture produced by the continuous trauma of the aorta against the osteophyte. The authors believe that this case reveals a possible new indication for treatment.

Massive Vertebral Destruction Associated With Chronic Rupture of Infrarenal Aortic Aneurysm

Case report and review of literature. To highlight the specific features of a rare, life-threatening, clinical picture. Vertebral erosion (VE) is rarely associated with contained rupture of an abdominal aortic aneurysm. The involvement of radicular nerves can mimic a discus hernia syndrome; eventually vertebral erosion induces isolated lower back pain. These features often lead to a delayed or wrong diagnosis of a life-threatening condition. Forty-two complete similar case reports have been published in the English literature since 1962. The most prevalent symptoms are low back pain and neurological signs due to compression of radicular nerves. A 73-year-old man presented to Vascular Surgery department complaining of continuous pain in the lumbar region during the previous 6 months. The duplex examination revealed a huge infrarenal aortic aneurysm with an undefined posterior wall. Spiral CT and MR scan confirmed the aneurysm and a scalloping of the second and third lumbar vertebral bodies. A double-team intervention, vascular and orthopedic, consisted in aneurysm graft replacement; vertebral bodies excision and anterior and posterior spinal stabilization. Postoperatively the patient experienced reversible respiratory and renal failure and was discharged home in good health after 30 days. The presence of aortic abdominal aneurysm is always to be considered in the evaluation of an elderly patient complaining lower back pain or lower limb neuropathy of recent onset, especially in the presence of a degenerative process of the spine.

Rupture of Infra-renal Aortic Aneurysm after Endovascular Repair: A Series from EUROSTAR Registry

Objectives. Although small, the risk of rupture after EVAR remains a major concern. The aim of this study was to identify mechanisms of late aneurysm rupture after endovascular repair. Methods. Patients who suffered a proven aneurysm rupture after EVAR were identified from the EUROSTAR (European Collaborators on Stent-graft Techniques for Abdominal Aortic Aneurysm Repair) registry. Complications preceding rupture were studied to identify common patterns and possible mechanisms of late rupture. Results. A rupture was documented in 34 patients resulting in death of 21 (62%). Adverse events documented during previous follow-up in these patients included endoleak (30%), migration (18%), limb occlusion (12%) and kinking (12%). The findings at time of rupture were documented in 24 patients and including endoleak: Type III (10), Type I (9), Type II (1); stent-graft disintegration (2) and migration (3). Aneurysm diameter changes could be ascertained in 24 patients and had increased in only seven. Conclusion. The importance of graft-related endoleak, stent-graft disintegration and migration in the causation of aneurysm rupture was confirmed. Poor compliance with follow-up schedule was also identified as a common feature. However, the absence of complications in some patients, who attended regularly for follow-up, highlights the difficulty of predicting rupture after EVAR.

Retrograde cerebral perfusion: Clinical experience in emergency and elective aortic operations

We recently have used retrograde cerebral perfusion via the superior vena cava in association with hypothermic circulatory arrest as an adjunct to cerebral protection during aortic arch operations. Between April 1993 and March 1994, 23 patients (14 male; 9 female; median age, 64 years; age range, 25 to 76 years; 14 emergency, 9 elective) underwent operation on the ascending aorta, aortic arch, or both for acute dissection (11) or aneurysm (12). Aortic root replacement was performed in 13 patients (7 with arch replacement), ascending aortic replacement in 7 (4 with arch replacement), isolated aortic arch replacement in 2, and repair of sinus of Valsalva aneurysm in 1. Coronary artery bypass grafting was performed in 4 patients. Hypothermic circulatory arrest (15 degrees C) and retrograde cerebral perfusion were implemented in all cases (median circulatory arrest time, 21 minutes; range, 13 to 51 minutes; median retrograde cerebral perfusion time, 20 minutes; range, 12 to 50 minutes). Three hospital deaths occurred (atheromatous embolic stroke, sepsis, rupture of infrarenal aortic aneurysm). The remaining patients had no neurologic damage (median intensive therapy unit stay, 1 day; range, 1 to 5 days). Retrograde cerebral perfusion is easy to establish and safe, and may improve brain protection during hypothermic circulatory arrest.