title: Small ruptured abdominal aortic aneurysm with renal failure: endovascular treatment--a case report.
abstract: The successful endovascular exclusion of a ruptured 3-cm diameter atherosclerotic abdominal aortic aneurysm (AAA) in a high-risk patient with renal failure is reported. An 82-year-old man with chronic renal failure and other comorbidities was admitted for acute abdominal pain. Duplex scan and computed tomography showed a ruptured 3-cm diameter atherosclerotic AAA. As a consequence of the patient's high surgical risk combined with signs of rupture, despite the progressively decreasing renal function, an emergency exclusion of the AAA was performed by means of a bifurcated Excluder (W. L. Gore and Associates) endovascular graft. The procedure was performed by minimizing administration of iodinated contrast medium using a guidewire into the lowest renal artery as a marker of proximal deployment. Intravascular ultrasound was used to confirm correct deployment. The postoperative recovery was characterized by acute renal insufficiency and bowel ischemia, which were treated with ultrafiltration and medical therapy, respectively, with complete resolution.
authors.affiliation: Department of Vascular Surgery, Università Vita-Salute, IRCCS H. San Raffaele, Via Olgettina 60, Postal Code 20132, Milan, Italy. g.melissano@hsr.it
authors.forename: Germano
authors.initials: G
authors.lastname: Melissano
authors.forename: Marcelo R L
authors.initials: MR
authors.lastname: Moura
authors.forename: Yamume
authors.initials: Y
authors.lastname: Tshomba
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Marone
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D014656:Vascular Surgical Procedures