Endovascular repair of a symptomatic aneurysm 5 years after AneuRx exclusion: off-label use of reversed talent aortomonoiliac stent-grafts.
OBJECTIVE
To describe the off-label use of 2 Talent aortomonoiliac devices to repair a symptomatic 72-mm abdominal aortic aneurysm (AAA) 5 years after AneuRx repair in a patient who had no follow-up.


METHODS
A 68-year-old man was referred to our hospital with a history of severe abdominal and back pain for 3 days. Five years earlier, he received an AneuRx stent-graft for an asymptomatic 51-mm infrarenal AAA, but he had not appeared for scheduled follow-up examinations. Computed tomographic angiography (CTA) showed a 72-mm AAA with bilateral common iliac aneurysms of 25 and 24 mm, respectively. The aortic segment of the AneuRx stent-graft appeared to be migrated distally by at least 20 mm; however, no type I endoleak was visible. Both distal iliac ends of the AneuRx stent-graft were migrated proximally and appeared to be floating free in the aneurysm sac, causing a bilateral type I endoleak distally. At operation, a 28-mm Talent aortic extension was inserted and dilated to cover the proximal migration zone. A Talent 28x16x126-mm aortomonoiliac stent-graft was reversed, re-installed into the deployment device, and deployed into the right AneuRx limb. The same procedure was followed on the left side, with deployment of a reversed 26x16x126-mm aortomonoiliac device. Angiography showed a fully excluded aneurysm with good anchoring of both stent-grafts. The patient was discharged on the third postoperative day in good general condition, without evidence of endoleak. At 3 and 6 months, CTA demonstrated no change in the position of the stent-graft and no signs of endoleak.


CONCLUSIONS
The off-label use of a reversed aortomonoiliac stent-graft is an easy alternative to the well-known technique of a distally placed aortic extension cuff and also eliminates the risk of a type III endoleak.
Teijink
Joep A W
JA
Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands. jaw.teijink@home.nl
Lim
Robert F
RF
D000792:Angiography; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents / Q000009:adverse effects*