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      Relining technique for continuous sac enlargement and modular disconnection secondary to endotension after endovascular aortic aneurysm repair

      case-report

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          Abstract

          Endotension is an unpredictable late complication of endovascular aortic aneurysm repair (EVAR). This case report will discuss the successful treatment of enlarged aneurysmal sac due to endotension using the relining technique. An 81-year-old male complained of nondecreasing huge aneurysm sac. He had undergone EVAR for infrarenal abdominal aortic aneurysm 7 years prior and no endoleak was found through follow-up. Initially computed tomography-guided sac aspiration was tried, but in vain, Relining using the double barrel technique and tubular endograft for modular diconnection, which was unexpectedly found in the original endograft, were performed sucessfully. During follow-up after the relining procedure, the size of aneurysm sac continued to decrease in size. The relining technique is effective mothod for treating endotension.

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          Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.

          F Moll, J T Powell, G Fraedrich … (2011)
          Article 0 comments Cited 224 times – based on 0 reviews     Review now
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            SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary.

            Elliot L Chaikof, David Brewster, Ronald L Dalman … (2009)
            Article 0 comments Cited 61 times – based on 0 reviews     Review now
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              Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report.

              , Karen J Buth, Roel Hobo (2006)
              The purpose of this study was to evaluate the need for secondary interventions after endovascular abdominal aortic aneurysm repair with current stent-grafts. Studied were data from 2846 patients treated from December 1999 until December 2004. The data were recorded from the EUROSTAR registry. The only patients studied were those with a follow-up of at least 12 months or until they had a secondary intervention within the first 12 months. The cumulative incidences of secondary transabdominal, extra-anatomic, and transfemoral interventions during follow-up (after the first postoperative month) were investigated. A secondary intervention was performed in 247 patients (8.7%) at a mean of 12 months after the initial procedure within a follow-up period of a mean of 23 +/- 12 months. Of these, 57 (23%) transabdominal, 43 (16%) involved an extra-anatomic bypass, and 147 (60%) were by transfemoral approach. The cumulative incidence of secondary interventions was 6.0%, 8.7%, 12%, and 14% at 1, 2, 3, and 4 years, respectively. This corresponded with an annual rate of secondary interventions of 4.6%, which was remarkably lower than in a previously published EUROSTAR study of patients treated before 1999. Type I endoleaks (33% of procedures), migration (16%), and rupture (8.8%) were the most frequent reasons for secondary transabdominal interventions. Graft limb thrombosis was the indication for extra-anatomic bypass (60%). Type I endoleak (17%), type II endoleak (23%), device limb stenosis (14%), thrombosis (23%), and device migration (14%) were the most frequent reasons for secondary transfemoral interventions. Operative mortality was higher after secondary transabdominal interventions (12.3%, P = .007) compared with transfemoral interventions (2.7%). Overall survival was lower in patients with secondary transabdominal (P = .016) and extra-anatomic interventions (P < .0001) compared with patients without a secondary intervention. Although the incidence of secondary interventions after endovascular aneurysm repair has substantially decreased in recent years, continuing need for surveillance for device-related complications remains necessary.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Surg Treat Res
                Journal ID (iso-abbrev): Ann Surg Treat Res
                Journal ID (publisher-id): ASTR
                Title: Annals of Surgical Treatment and Research
                Publisher: The Korean Surgical Society
                ISSN (Print): 2288-6575
                ISSN (Electronic): 2288-6796
                Publication date (Print): March 2014
                Publication date (Electronic): 24 February 2014
                Volume: 86
                Issue: 3
                Pages: 161-164
                Affiliations
                Department of Surgery, Inha University School of Medicine, Incheon, Korea.
                [1 ]Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
                [2 ]Division of Vascular Surgery, Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea.
                [3 ]Department of Radiology, Inha University School of Medicine, Incheon, Korea.
                Author notes
                Corresponding Author: Kee Chun Hong. Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea. Tel: +82-32-890-2738, Fax: +82-32-890-3549, keechong@ 123456inha.ac.kr
                Article
                DOI: 10.4174/astr.2014.86.3.161
                PMC ID: 3994625
                PubMed ID: 24761425
                SO-VID: e28fb2c8-a8b0-4643-b97d-e4d7b1853656
                Copyright © Copyright © 2014, the Korean Surgical Society
                License:

                Annals of Surgical Treatment and Research is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 05 September 2013
                Date revision received : 10 October 2013
                Date accepted : 10 October 2013
                Funding
                Funded by: Inha University research fund
                Categories
                Subject: Case Report

                Keywords: aortic aneurysm,endovascular procedures,endoleak,complication
                Data availability:
                Keywords: aortic aneurysm, endovascular procedures, endoleak, complication

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