A Rare Complication After Endovascular Aneurysm Repair: Disconnection of the Suprarenal Stent of a Zenith Endograft

Abstract

Purpose: To report a disconnection between the bare suprarenal stent and the main body of a Zenith endograft.

Case report: A 79-year-old man with a history of successful endovascular repair of an aortic aneurysm presented a sudden episode of hypotension and hematuria. He had undergone implantation of a Zenith bifurcated device 8 years earlier in 2006. Plain abdominal radiography and computed tomography showed disconnection of the uncovered proximal stent, which led to endograft migration and type Ia endoleak. The patient also presented with distal endoleaks at the attachment sites in both common iliac arteries. The aneurysm sac diameter had increased from 52 to 96 mm. A proximal aortic cuff and bilateral iliac extensions were deployed via a common femoral artery access. Completion angiography did not show endoleak.

Conclusion: After publication of a few such cases with the older Zenith device, the union between the suprarenal stent and main body was reinforced in 2002 to prevent this complication. Since modification of the device, this sequela had not been described. The reappearance of this complication underscores the need for continued surveillance, considering that these late events may require a reintervention to maintain the clinical success of the procedure.

Keywords: abdominal aortic aneurysm; complication; endograft; endoleak; endovascular aneurysm repair; migration; stent disconnection; stent-graft.