title: Hemodynamic Conditions may Influence the Oversizing of Stent Grafts and the Postoperative Surveillance of Patients with Ruptured Abdominal Aortic Aneurysm Treated by EVAR.
abstract: BACKGROUND
  To report the causes of second rupture in patients treated with a stent graft for ruptured abdominal aortic aneurysm (rAAA).
  
  
  METHODS
  A 69-year-old man was admitted for abdominal pain and hypovolemic shock 22 months after endovascular exclusion of an rAAA with an aortomonoiliac stent graft and a crossover bypass despite normal duplex ultrasound and sac shrinkage at 1 year. During emergent laparotomy, a type IA endoleak was discovered and the aortomonoiliac stent graft was explanted. A Dacron bypass was interposed between the infrarenal aorta and the iliac extension stent graft.
  
  
  CONCLUSIONS
  Considering the literature, this report has 3 implications for the endovascular treatment of rAAA. First, 30% oversizing is preferable to 15% when treating an rAAA assessed by computed tomography angiography (CTA) performed during permissive hypotension. Second, the surveillance program should rely on CTA and not on a duplex examination to detect any endoleaks or migration. Finally, partial stent graft explantation is a valid option for decreasing aortic clamping time.
authors.affiliation: Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gonthier
authors.affiliation: Vascular Surgery Department, CHUV, Lausanne, Switzerland.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Deglise
authors.affiliation: Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Brizzi
authors.affiliation: Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Ducasse
authors.affiliation: Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Midy
authors.affiliation: Vascular Surgery Department, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Lachat
authors.affiliation: Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France. Electronic address: xavier.berard@chu-bordeaux.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Berard
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000150:complications*; D008297:Male; D017755:Prosthesis Fitting / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects*