title: Percutaneous treatment of sac rupture in abdominal aortic aneurysms previously excluded with endovascular repair (EVAR).
abstract: The purpose of this study was to assess the feasibility and effectiveness of percutaneous endovascular repair of ruptured abdominal aortic aneurysms (AAAs) previously treated by EVAR. In the last year, two male patients with AAAs, treated 8 and 23 months ago with bifurcated stent-graft, were observed because of lumbar pain and hemorragic shock. Multidetector computed tomography (MDCT) showed a retroperitoneal hematoma; in both cases a type III endoleak was detected, in one case associated with a type II endoleak from the iliolumbar artery. The procedures were performed in the theater, in emergency. Type II endoleak was treated with transcatheter superselective glue injection; type III endoleaks were excluded by a stent-graft extension. The procedures were successful in both patients, with immediate hemodynamic stabilization. MDCT after the procedure showed complete exclusion of the aneurysms. In conclusion, endovascular treatment is a safe and feasible option for the treatment of ruptured AAAs previously treated by EVAR; this approach allows avoidance of surgical conversion, which is technical very challenging, with a high morbidity and mortality rate.
authors.affiliation: Department of Radiology, University of Insubria, Viale Borri, Varese, Italy. donlaga@gmail.com
authors.forename: Domenico
authors.initials: D
authors.lastname: Laganà
authors.forename: Monica
authors.initials: M
authors.lastname: Mangini
authors.forename: Federico
authors.initials: F
authors.lastname: Fontana
authors.forename: Paolo
authors.initials: P
authors.lastname: Nicotera
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
authors.forename: Carlo
authors.initials: C
authors.lastname: Fugazzola
mesh_terms: D000368:Aged; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents; D014057:Tomography, X-Ray Computed