title: Repair of a Contained Ruptured Paravisceral Aortic Aneurysm Using a Surgeon-Modified Fenestrated Endograft and Development of an Aortogastric Fistula.
abstract: Complex aortic aneurysms such as paravisceral aneurysm represent a challenging condition especially in the case of rupture. The presence of an aortoenteric fistula in this setting is associated with a very high mortality and morbidity. We report the case of a 72-year-old patient with contained ruptured paravisceral aortic aneurysm who underwent surgeon-modified fenestrated endovascular aneurysm repair (sm-fEVAR) with fenestrations for multiple renal arteries and the superior mesenteric artery. The patient successfully recovered from the repair but developed an aortogastric fistula on the basis of a preexisting gastric ulceration so that second-stage atypical gastrectomy was conducted. The further postoperative course was complicated by severe pancreatitis and sepsis resulting in multiorgan failure and in-hospital death 1.5 months later. We were able to demonstrate the technical feasibility of an sm-fEVAR for a contained ruptured paravisceral aneurysm. Coverage of the celiac artery is required in some complex cases but may lead to severe ischemic complication despite from angiographic sufficient collateralization.
authors.affiliation: Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany. Electronic address: f.heidemann@uke.de.
authors.forename: Franziska
authors.initials: F
authors.lastname: Heidemann
authors.affiliation: Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Diener
authors.affiliation: Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Debus
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Perez
authors.affiliation: Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
authors.affiliation: Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsilimparis
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation*; D017809:Fatal Outcome; D005743:Gastrectomy; D005747:Gastric Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery; D009102:Multiple Organ Failure / Q000209:etiology; D010195:Pancreatitis / Q000209:etiology; D012077:Renal Artery / Q000601:surgery; D012086:Reoperation; D018805:Sepsis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery