Endovascular treatment of late "endoleak" following open surgical repair using bypass and exclusion aneurysm repair.
BACKGROUND
We sought to present endovascular management options of persistent or recurrent aneurysm sac flow ("endoleak") after operative retroperitoneal exclusion of infrarenal abdominal aortic aneurysm (AAA).


METHODS
Recurrent or persistent aneurysm perfusion was diagnosed in three patients primarily treated with aneurysm exclusion and bypass. The medical history, course of disease, and surgical management of these patients were reviewed.


RESULTS
Three patients primarily treated for infrarenal AAA by division of the aorta with suture closure of the proximal aneurysm end, ligation of the outflow vessels, and bypass of the excluded aortoiliac segment presented with persistent or recurrent AAA sac perfusion and growth. The feeding vessels were the iliac arteries in all cases. Endovascular repair using coil embolization and/or deployment of an occluder or stent-graft was successful in all patients with a follow-up of 42, 36, and 30, months respectively.


CONCLUSIONS
Open AAA repair using the exclusion and bypass technique is associated with the risk of persistent perfusion or reperfusion of the aneurysm sac, which is similar to an endoleak after endovascular aortic aneurysm exclusion. Endovascular therapy should be considered as first-choice treatment when feasible.
Tsilimparis
Nikolaos
N
Klinik für Chirurgie/Gefässmedizin, Franziskus-Krankenhaus, Akademisches Lehrkrankenhaus der Charité, Universitätsmedizin, Berlin, Germany. nikolaos.tsilimparis@charite.de
Yousefi
Sharham
S
Hanack
Ulrich
U
Alevizakos
Pavlos
P
Rückert
Ralph Ingo
RI
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome