title: Infrarenal abdominal aortic aneurysm complicated by persistent endotension after endovascular repair: report of a case.
abstract: Endoleak and endotension may prevent the successful exclusion of an aneurysm after endovascular aortic aneurysm repair (EVAR). The pressurization in the excluded aneurysm sac caused by endotension may lead to rupture of the aneurysm; however, the cause of endotension and its underlying mechanisms remain unclear. We report a case of infrarenal abdominal aortic aneurysm (AAA) complicated by persistent endotension after EVAR. Although no endoleaks were found on conventional double-phase computed tomographic scans, a thrombosed endoleak existed in the side branch and attachment site of the endograft. After treating the undetectable thrombosed endoleaks, physical examination revealed that the pressure of the excluded aneurysm had diminished, with shrinkage of the aneurysm. This case report suggests that a high-pressure undetectable type I or type II endoleak could be a major cause of endotension. Thus, postoperative evaluation of the attachment site of an endograft is important after EVAR.
authors.affiliation: Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka, 570-8507, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Imamura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Koike
authors.forename: Ryuji
authors.initials: R
authors.lastname: Iwaki
authors.forename: Takamichi
authors.initials: T
authors.lastname: Saito
authors.forename: Takashi
authors.initials: T
authors.lastname: Ozaki
authors.forename: Hironori
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamada
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kamiyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D011312:Pressure; D012077:Renal Artery; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods