Midaortic pseudoaneurysm complicating extensive endovascular stenting of aortic disease.
We report a case of successful surgical management of a potentially life-threatening complication of aortoiliac stent placement. A 59-year-old man who had Leriche syndrome underwent bilateral iliac artery and infrarenal aortic stent placement at another institution. His history was significant for retroperitoneal lymph node dissection at 19 years of age for testicular cancer. One week after stent placement, the patient was readmitted with abdominal pain, poor oral intake, and diffuse intermittent tenderness. Evaluation with computed tomographic scanning and endoscopy was unremarkable, and the patient was discharged. He was admitted to our institution 1 week later with persistent abdominal pain. A computed tomographic scan of the abdomen revealed a large pseudoaneurysm of the abdominal aorta. The patient underwent urgent exploration, and exclusion of his infrarenal aorta was achieved with aortobifemoral bypass grafting. After the operation, the patient's course was complicated by a large paraduodenal hematoma, which resulted in a gastric outlet obstruction, which was managed without operation. This case illustrates a potential life-threatening complication of extensive stent placement for aortoiliac occlusive disease. Injury to the abdominal aorta must be considered in a symptomatic patient after the placement of stents in the aortoiliac region, beyond the immediate periprocedural period.
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Department of Surgery, Brown University School of Medicine, Providence, R.I., USA.
Whitley
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Patterson
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D015746:Abdominal Pain / Q000209:etiology; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007925:Leriche Syndrome / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed