title: Late rupture after EVAR: a new trend?
abstract: OBJECTIVE
  Endovascular aortic repair (EVAR) is an adequate therapy for abdominal aortic aneurysms (AAA). Late aortic ruptures caused by endoleaks after EVAR still remain a critical issue. The aim of this study was to assess the causes of ruptured aortic aneurysms after EVAR in a single center study.
  
  
  METHODS
  All patients, who were treated in our University hospital with a ruptured juxtra- or infrarenal AAA between January 2011 and October 2013, were included in this retrospective analysis.
  
  
  RESULTS
  Thirty patients with ruptured infra- or juxtrarenal aneurysms were treated in this time frame. Six out of these 30 patients had previous EVAR repair. The median maximal aneurysm diameter of these post-EVAR patients was 82 (75-95) mm. The median time between primary EVAR and rupture was 42.5 (14-99) months. Three patients with type Ia endoleaks were treated by stent removal and conventional aortic reconstruction. In two patients with type II endoleak the bleeding was controlled by occluding the back bleeding lumbar arteries. One type III endoleak was sealed by an additional stent-graft implantation into the right iliac artery.
  
  
  CONCLUSIONS
  We observed a considerable number of patients with a ruptured AAA after EVAR. Surprisingly, we observed two ruptured aneurysms due to type II endoleaks.
authors.affiliation: Department of Vascular Surgery European Vascular Center, Aachen‑Maastricht RWTH University Hospital, Aachen, Germany - m.jacobs@mumc.nl.
authors.forename: A
authors.initials: A
authors.lastname: Greiner
authors.forename: K
authors.initials: K
authors.lastname: Schleimer
authors.forename: H
authors.initials: H
authors.lastname: Jalaie
authors.forename: A
authors.initials: A
authors.lastname: Gombert
authors.forename: M J
authors.initials: MJ
authors.lastname: Jacobs
authors.forename: J
authors.initials: J
authors.lastname: Kalder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006489:Hemostatic Techniques; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009426:Netherlands; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome