Spontaneous rupture of the visceral abdominal aorta: endovascular management using the periscope graft technique.
OBJECTIVE
To describe the endovascular management of a spontaneous rupture of the visceral abdominal aorta.


METHODS
A 69-year-old man presented as an emergency with a ruptured non-aneurysmal visceral abdominal aorta that extended from just below the celiac trunk to the right renal artery; the superior mesenteric artery (SMA) appeared to be occluded. The rupture was presumed to be due to a penetrating atherosclerotic ulcer. An endovascular approach was devised in which an Excluder aortic cuff would be deployed immediately below the origin of the celiac artery, covering the ruptured aortic segment and the occluded SMA. However, a second cuff was required distally to seal the rupture. To maintain perfusion to the right renal artery, a Viabahn stent-graft was deployed into the renal artery using the periscope technique. A stent was also required in the celiac trunk, which had been inadvertently covered. The patient had an uneventful recovery; follow-up imaging at 1 year revealed no endoleak and resolution of the hematoma.


CONCLUSIONS
Spontaneous rupture of a non-aneurysmal visceral abdominal aorta is extremely challenging and potentially fatal. Endovascular management using the periscope stent-graft technique to facilitate aortic stent-grafting may offer an attractive bailout option with satisfactory early results.
The 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocrateio Hospital, Thessaloniki, Greece.
Konstantinos O
KO
Papazoglou
Christos D
CD
Karkos
Ioakeim T
IT
Giagtzidis
Thomas E
TE
Kalogirou
Andreas
A
Eliescu
D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012422:Rupture, Spontaneous; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome