Aortic Dehiscence During Endovascular Sealing for Ruptured Abdominal Aortic Aneurysms.
OBJECTIVE
To present a case of aneurysm disruption during endovascular sealing of a ruptured abdominal aortic aneurysm.


METHODS
A 91-year-old woman presented with a ruptured abdominal aortic aneurysm. Her aneurysm morphology was unsuitable for standard or fenestrated endovascular repair, whereas open repair was considered to have an increased perioperative risk owing to multiple comorbidities. The Nellix endovascular sealing system was used. The balloon-expandable stent-grafts were deployed, but in the presence of aneurysm rupture, it was decided not to prefill the endobags with saline. The patient developed hypotension during endobag filling, which resolved once target pressure was reached. The procedure was completed uneventfully, and the completion angiogram revealed no endoleak. The time from guidewire insertion to completion angiogram was 24 minutes. Over the following days, she developed a gradual drop in hemoglobin, and computed tomographic angiography revealed an increased retroperitoneal hematoma and pronounced disruption of the calcified rim of the aortic sac compared to the preoperative imaging. She was managed with supportive treatment, demonstrating remarkable progress. She remains in good health 4 months later.


CONCLUSIONS
Endovascular sealing can be used in patients with ruptured abdominal aortic aneurysm. Intraoperative endobag saline prefill should be avoided to minimize the risk of aortic wall disruption.
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK antoniou.ga@hotmail.com.
George A
GA
Antoniou
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
Francesco
F
Torella
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
Gareth J
GJ
Harrison
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
Simon
S
Neequaye
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
Richard G
RG
McWilliams
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
Robert K
RK
Fisher
D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D013529:Surgical Wound Dehiscence; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
abdominal aortic aneurysm; aneurysm rupture; aortic wall disruption; endovascular aneurysm sealing