title: Endovascular treatment of a multimorbid patient with late AAA rupture after stent-graft placement: 1-year follow-up.
abstract: OBJECTIVE
  To report successful endovascular management of a ruptured abdominal aortic aneurysm (AAA) in a multimorbid patient 40 months after primary stent-grafting.
  
  
  METHODS
  A 64-year-old man presented with hypotension, severe back pain, and abdominal distension. Immediate computed tomography revealed a proximal type I endoleak due to distal migration of the stent-graft with subsequent rupture of the aneurysm. The patient was hemodynamically unstable, and open surgery was refused because of severe comorbidities that were the indications for initial endovascular repair. The diameter of the proximal aneurysm neck required the use of a thoracic stent-graft that was overly long, which led to occlusion of the contralateral stent-graft limb supplying not only the left leg but also a left kidney transplant. A crossover bypass was implanted to revascularize both.
  
  
  CONCLUSIONS
  Minimally invasive strategies, even when challenged by complex vascular reconstructions, offer the possibility of managing ruptured aortic aneurysms in patients unsuitable for open surgery.
authors.affiliation: Department of Vascular Surgery, University of Vienna Medical School, Vienna, Austria. alexanderprusa@hotmail.com
authors.forename: Harald
authors.initials: H
authors.lastname: Teufelsbauer
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Prusa
authors.forename: Manfred
authors.initials: M
authors.lastname: Prager
authors.forename: Siegfried
authors.initials: S
authors.lastname: Thurnher
authors.forename: Johannes
authors.initials: J
authors.lastname: Lammer
authors.forename: Thomas
authors.initials: T
authors.lastname: Hölzenbein
authors.forename: Georg
authors.initials: G
authors.lastname: Kretschmer
authors.forename: Ihor
authors.initials: I
authors.lastname: Huk
authors.forename: Peter
authors.initials: P
authors.lastname: Polterauer
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures