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      Endovascular Repair of an Unusually Complex Anastomotic Pseudoaneurysm of an Aorto-Bisiliac Graft

      case-report

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          Background

          Anastomotic pseudoaneurysm is an underestimated complication of aorto-iliac grafts.

          Case Report

          This case report describes an unusual presentation of a pseudoaneurysm with a particularly complex anatomy involving both the left iliac branches, which hindered the interpretation of diagnostic studies and therapeutic management in a patient with multiple comorbidities.

          Conclusions

          The manuscript describes a successful management of such a complication by means of an elective endovascular approach.

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          Most cited references13

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          The durability of endovascular repair of para-anastomotic aneurysms after previous open aortic reconstruction.

          Jan Ten Bosch, Evert J. Waasdorp, Jean-Paul de Vries … (2011)
          Anastomotic pseudoaneurysms and true para-anastomotic aneurysms after initial open abdominal aortic prosthetic reconstruction often need reintervention because they are at risk for rupture. However, open surgical reinterventions are technically challenging procedures with high mortality and morbidity rates. In the present multicenter study, we describe the long-term clinical course in an expanded number of patients who underwent endovascular repair of para-anastomotic aneurysms after previous open reconstruction.
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            Paraanastomotic aneurysms of the abdominal aorta: a 15-year experience review.

            E Costantini, P Locati, A Socrate (2000)
            The aim of the study is a retrospective review of clinical presentation and management of paraanastomotic aneurysms of the abdominal aorta (PAAA) surgically treated in our Department. From January 1984 to December 1998, 2183 aortic prosthetic grafts were implanted. During the same period, 24 patients were treated for PAAA, 19 false and five true aneurysms. Symptoms were present in 10 patients. Surgical management included tube grafting interposition (14), aortobifemoral bypass (2), graft removal with extraanatomic bypass (2) and with in situ revascularization by arterial homograft (4). Nine patients died during operation or in the early postoperative period, six died during follow-up. Mortality in symptomatic patients was 70%, while in asymptomatic group was 14% (P=0.01). Rupture of false PAAA was very frequent (47% of cases). PAAA are infrequent complications of proximal aortic graft revascularization and tend to be asymptomatic until rupture occurs. The incidence of mortality is very different in asymptomatic versus symptomatic group; rupture is particularly frequent in false PAAA, which must soon undergo surgery when diagnosed. Since PAAA may develop at any time after surgery, their incidence increase in relationship with the length of postoperative interval: therefore, all patients submitted to abdominal graft revascularization need a lifetime surveillance program.
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              Endovascular treatment of anastomotic false aneurysms of the abdominal aorta.

              Filbert J. Bartoli, A Branchereau, N Valério … (2003)
              Conventional surgical treatment of anastomotic false abdominal aortic aneurysms (AFAA) is technically difficult. Morbidity-mortality rates are higher than those for surgery of infrarenal abdominal aortic aneurysm (AAA). Endovascular management without laparotomy or aortic clamping represents an attractive alternative. The purpose of this study was to determine the immediate and middle-term outcome of endovascular management of AFAA. Between 1998 and 2001, 10 patients were treated for AFAA by placement of an endograft. The initial procedure was aortobifemoral bypass for occlusive artery disease in eight cases and resection and grafting for AAA in two cases. Mean age was 70 years. Seven patients were classified ASA 3 or 4. Three patients presented cardiac insufficiency with left ventricular ejection fraction <40%. Eight patients were treated using an aortounilateral iliac artery endograft in association with crossover femorofemoral bypass (3 AneuRx, 2 Endologix, 1 Talent, 1 Zenith, 1 surgeon-made stent). Two patients were treated with an aortoaortic endograft (1 Talent, 1 surgeon-made stent). In two patients extraperitoneal exposure of the common iliac artery was required for introduction of the stent in one case and for surgical closure of the iliac artery in the other case. A total of nine patients underwent another surgical procedure in association with stenting. Four endografts were custom-made. Endograft deployment was successful in all cases. No patient died during the postoperative period. Postoperative computed tomography (CT) scan confirmed exclusion of the aneurysmal sac in all cases. The mean duration of hospitalization was 13 days (range, 5-28 days). During follow-up (mean duration, 17.7 months; range, 5-42 months), one patient died from heart-related causes. No direct or indirect endoleak was detected by CT scan follow-up and a significant reduction in AFAA diameter was noted in the eight patients with follow-up periods lasting 6 months or more. One patient developed occlusion of an aortounilateral iliac artery endograft and was treated by axillobifemoral bypass. In one patient stenosis of the distal end of an aortounilateral iliac endograft was discovered by duplex scan and successfully treated by dilatation. Endovascular treatment of AFAA is technically feasible but requires more complex procedures involving associated surgical procedures and use of custom-made endografts. The morbidity-mortality rate in this small series of high-risk patients was low. Immediate and middleterm exclusion of AFAA was good.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pol J Radiol
                Journal ID (iso-abbrev): Pol J Radiol
                Journal ID (publisher-id): Pol J Radiol
                Title: Polish Journal of Radiology
                Publisher: International Scientific Literature, Inc.
                ISSN (Print): 1733-134X
                ISSN (Electronic): 1899-0967
                Publication date Collection: 2017
                Publication date (Electronic): 01 May 2017
                Volume: 82
                Pages: 244-247
                Affiliations
                [1 ]Department of Radiology – Interventional Radiology Unit, University Hospital of Verona, Polo Chirurgico “P. Confortini”, Verona, Italy
                [2 ]Department of Vascular Surgery, University Hospital of Verona, Polo Chirurgico “P. Confortini”, Verona, Italy
                Author notes
                Author’s address: Mirko Trentadue, Department of Radiology – Interventional Radiology Unit, University Hospital of Verona, Polo Chirurgico “P. Confortini”, Piazzale Stefani 1, Verona, Italy, 37124, e-mail: m.trentadue@ 123456hotmail.it
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                Publisher ID: 899825
                DOI: 10.12659/PJR.899825
                PMC ID: 5424651
                PubMed ID: 28533827
                SO-VID: 210fddce-5277-456d-bf68-7536e0b6ded4
                Copyright © © Pol J Radiol, 2017
                License:

                This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.

                History
                Date received : 31 May 2016
                Date accepted : 29 August 2016
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: aneurysm, false,aortic aneurysm, abdominal,endovascular procedures
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: aneurysm, false, aortic aneurysm, abdominal, endovascular procedures

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