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Case Reports
. 2020 Nov 7;20(1):272.
doi: 10.1186/s12893-020-00933-2.

Successful emergency endovascular aortic repair for intratumoral hemorrhage in extensive retroperitoneal mass of testicular origin

S Hulova  1   2 , R Aziri  3   4 , I Vulev  5 , P Palacka  6   4 , G Kolnikova  7   4 , K Rejlekova  6   4 , M Chovanec  6   4 , J Mardiak  6   4 , D Pindak  3   4 , M Mego  6   4
Affiliations
Case Reports

Successful emergency endovascular aortic repair for intratumoral hemorrhage in extensive retroperitoneal mass of testicular origin

S Hulova et al. BMC Surg. .

Abstract

Background: Metastatic germ cell cancer of the testis is characterized by favorable prognosis since effective treatment methods are available even in cases of extensive disease. Retroperitoneal masses frequently encroach major blood vessels requiring a vascular intervention usually performed in association with the post-chemotherapy retroperitoneal lymph node dissection (RPLND). Reported clinical case describes a successful pre-treatment endovascular surgery for abdominal aortic rupture allowing for full-dose systemic chemotherapy administration, and subsequent radical surgical intervention at primary tumor site as well as metastatic retroperitoneal lymph node dissection including the reconstruction of inferior caval vein.

Case presentation: Patient presented with left-sided testicular tumor and voluminous retroperitoneal mass with vascular involvement. Soon after the patient had been admitted for the first cycle of cisplatin-based chemotherapy, computed tomographic angiography (CTA) revealed a dorsal aortic wall rupture with active extravasation and irregular pseudoaneurysmatic dilatation of the aorta below the leak area. Retroperitoneal intratumoral hemorrhage associated with the bilateral iliac venous thrombosis required an endovascular repair procedure of infrarenal abdominal aorta.

Conclusions: Following the successful endovascular aortic repair 3 cycles of BEP (bleomycin, etoposide, cisplatin) regimen were administered with subsequent delayed left radical orchiectomy and RPLND associated with vena cava inferior (VCI) resection. Reconstruction of VCI was originally not deemed necessary as collateral blood flow appeared sufficient, however, intraoperative complications resulted in the need for unilateral VCI reconstruction, using the interposed bypass between right common iliac vein and infrarenal segment of VCI. Histopathologic examination of the attained specimen detected no vital cancer structures. The patient remains disease-free 18 months after the RPLND.

Keywords: Advanced testicular cancer; Aortic rupture; Case report; Endovascular repair; Retroperitoneal tumor.

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Conflict of interest statement

No competing interests are associated with this paper.

Figures

Fig. 1
Fig. 1
CT scan showed active extravasation of contrast agent into retroperitoneal tumor mass. ( transversal view)
Fig. 2
Fig. 2
Two Endurant abdominal stentgrafts were successfully implanted via right common femoral artery
Fig. 3
Fig. 3
Restaging CT scan (coronal view). Aortic endograft (black arrow), venous PTFE endograft (white arrow)
See this image and copyright information in PMC

References

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