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Case Reports
. 2018 Jan-Mar;17(1):66-70.
doi: 10.1590/1677-5449.008017.

Late open conversion in ruptured abdominal aortic aneurysm after endovascular repair

Erol Kurç  1 , Onur Sokullu  1 , Serdar Akansel  1 , Murat Sargın  1
Affiliations
Case Reports

Late open conversion in ruptured abdominal aortic aneurysm after endovascular repair

Erol Kurç et al. J Vasc Bras. 2018 Jan-Mar.

Abstract
in English, Portuguese

Despite technological advances, the long-term outcomes of endovascular aortic aneurysm repair (EVAR) are still debatable. Although most endograft failures after EVAR can be corrected with endovascular techniques, open conversion may still be required. A 70-year-old male patient presented at the emergency unit with abdominal pain. Twice, in the third and fourth years after the first repair, a stent graft had been placed over a non-adhesive portion of the stent graft due to type Ia endoleaks. In the most recent admission, a CT scan showed type III endoleak and ruptured aneurysm sac. On this occasion the patient underwent late open conversion. The failure was repaired with total preservation of the main endovascular graft body and interposition of a bifurcated dacron graft. This case demonstrates that lifelong radiographic surveillance should be considered in this subset of patients. Late open conversion following EVAR of ruptured abdominal aortic aneurysms can be performed safely.

Apesar dos avanços tecnológicos, os desfechos de longo prazo do reparo endovascular de aneurismas da aorta abdominal (endovascular aortic aneurysm repair – EVAR) ainda são objeto de debate. Embora a maioria das falhas de endoenxerto após EVAR possam ser corrigidas com técnicas endovasculares, conversão para cirurgia aberta ainda pode ser necessária. Um paciente de 70 anos de idade, do sexo masculino, apresentou-se no serviço de emergência com dor abdominal. Duas vezes, dois e quatro anos após o primeiro reparo, um enxerto foi colocado sobre uma porção não adesiva do stent devido a endoleak tipo Ia. Na mais recente hospitalização, a tomografia computadorizada mostrou endoleak tipo III e ruptura de um saco aneurismático. Nesta ocasião, o paciente foi submetido a conversão tardia para cirurgia aberta. A falha foi tratada com preservação total do corpo principal do enxerto endovascular e interposição de um enxerto tipo Dacron bifurcado. Este caso demonstra que a vigilância radiográfica ao longo de toda a vida deveria ser considerada nesse subgrupo de pacientes. Conversão tardia para cirurgia aberta após EVAR de aneurismas rotos da aorta abdominal pode ser realizada com segurança.

Keywords: EVAR; late open conversion; re-intervention; ruptured abdominal aortic aneurysm.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Reconstructed three-dimensional image shows a large, type Ia endoleak (arrow) and enlargement of the aneurysm to 120 mm in diameter, in the third year after the first repair.
Figure 2
Figure 2. Post-procedure 62-month CT-scan depicting a large, type III endoleak (graft disconnection arrowed) and enlargement of the aneurysm to 133 mm in diameter.
Figure 3
Figure 3. The aneurysm sac was opened under aortic cross-clamping. Disconnection of graft components is clearly visible (arrow).
See this image and copyright information in PMC

References

    1. Botsios S, Bausback Y, Piorkowski M, et al. Late open conversion after endovascular aneurysm repair. Interact Cardiovasc Thorac Surg. 2014;19(4):622–626. http://dx.doi.org/10.1093/icvts/ivu203 - DOI - PubMed
    1. Harris PL, Vallabhaneni SR, Desgranges P, Becquemin JP, van Marrewijk C, Laheij RJ. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience. J Vasc Surg. 2000;32(4):739–749. http://dx.doi.org/10.1067/mva.2000.109990 - DOI - PubMed
    1. Klonaris C, Lioudaki S, Katsargyris A, et al. Late open conversion after failed endovascular aortic aneurysm repair. J Vasc Surg. 2014;59(2):291–297. http://dx.doi.org/10.1016/j.jvs.2013.07.106 - DOI - PubMed
    1. Brinster CJ, Fairman RM, Woo EY, Wang GJ, Carpenter JP, Jackson BM. Late open conversion and explantation of abdominal aortic stent grafts. J Vasc Surg. 2011;54(1):42–46. http://dx.doi.org/10.1016/j.jvs.2010.12.042 - DOI - PubMed
    1. Moulakakis KG, Dalainas I, Mylonas S, Giannakopoulos TG, Avgerinos ED, Liapis CD. Conversion to open repair after endografting for abdominal aortic aneurysm: a review of causes, incidence, results, and surgical techniques of reconstruction. J Endovasc Ther. 2010;17(6):694–702. http://dx.doi.org/10.1583/1545-1550-17.6.694 - DOI - PubMed

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