Endovascular treatment of a noninfected anastomotic juxtarenal aortic aneurysm

Abstract

An 82-year-old man underwent an endovascular procedure with a commercially available endovascular graft for an anastomotic juxtarenal abdominal aortic aneurysm. The anastomotic aneurysm, which showed no sign of infection, developed 4 years after implantation of an aortic end-to-end graft for an infrarenal aortic aneurysm. The aneurysm was diagnosed during routine ultrasonographic follow-up; there was no apparent infection of the graft. Aortography confirmed the diagnosis and also revealed a small pseudoaneurysm at the level of the distal aortic anastomosis. Endovascular surgery was performed in the operating room with the guidance of C-arm fluoroscopy and intravascular ultrasound. Two Vanguard Straight Endovascular Aortic Graft Cuffs (26 x 50 mm and 24 x 50 mm) were implanted, successfully excluding both the anastomotic juxtarenal aortic aneurysm and the distal pseudoaneurysm. The renal arteries were preserved and no early or late endoleaks were observed. The patient was discharged 2 days after the procedure. Sixteen months later, he was alive and well, with no endovascular leakage, no enlargement of the aortic aneurysms, and no sign of infection. In our opinion, this experience shows that commercially available endovascular grafts may be used successfully to treat anastomotic aortic aneurysms and pseudoaneurysms.

Fig. 1 Preoperative computed tomographic scan showing the anastomotic juxtarenal abdominal aortic aneurysm.

Fig. 2 Preoperative aortography performed with calibrated pigtail catheter showing 2 left renal arteries, an anastomotic juxtarenal abdominal aortic aneurysm (upper arrow), and a small distal pseudoaneurysm.

Fig. 3 Final intraoperative aortography: both pseudoaneurysms are excluded and the renal arteries are preserved.

Fig. 4 Schematic drawings of the anastomotic juxtarenal abdominal aortic aneurysm, end-to-end aortic graft, and final endograft positions.

Fig. 5 At the 6-month follow-up, computed tomographic scanning during a bolus injection of non-ionic iodinated contrast medium shows the patency of A) the renal artery at the level of the uncovered stent and B) the endograft.