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• W2089852964 abstract "A 61-year-old man presented to the emergency department with acute onset of severe abdominal and back pain. His surgical history was significant for thoracic endovascular aneurysm repair (TEVAR) 15 months earlier with a 34-mm endograft at another institution. Six months later, he had undergone elective endovascular abdominal aortic aneurysm repair (EVAR) with 28-mm bifurcated device. On physical examination, he was hypotensive and had a distended and firm abdomen. Computed tomography angiography of the chest, abdomen, and pelvis showed a rupture of the aneurysmal aortic segment between the previously placed TEVAR stent graft and EVAR stent grafts (A/Cover, B, and C). A type IB endoleak was also seen in the right iliac extension (B and C). The patient was brought emergently to the operating room. The aneurysmal segment was covered with a 32-mm straight endograft inferiorly and a 38-mm straight endograft superiorly. This covered the origins of celiac, superior mesenteric, and bilateral renal arteries. An exploratory laparotomy was performed, and right external iliac artery-to-superior mesenteric artery bypass was performed with an 8-mm polytetrafluoroethylene graft. Owing to the patient's hemodynamic instability and long operative time, the renal arteries were not revascularized. Postoperatively, the patient required dialysis. He did not have any sensory or motor loss in either extremity. The patient was discharged after a prolonged hospital stay of 5 weeks. The risk of aortic rupture after EVAR is 2.4% within 8 years after repair.1Leurs L.J. Buth J. Laheij R.J. Long-term results of endovascular abdominal aortic aneurysm treatment with the first generation of commercially available stent grafts.Arch Surg. 2007; 142 (discussion: 42): 33-41Crossref PubMed Scopus (84) Google Scholar The lifetime risk of rupture is even higher, because most patients live a long time after the procedure.2Schermerhorn M.L. Finlayson S.R. Fillinger M.F. Buth J. van Marrewijk C. Cronenwett J.L. Life expectancy after endovascular versus open abdominal aortic aneurysm repair: results of a decision analysis model on the basis of data from EUROSTAR.J Vasc Surg. 2002; 36: 1112-1120Abstract Full Text PDF PubMed Scopus (66) Google Scholar The mean interval between the initial procedure and subsequent abdominal aortic aneurysm rupture is 24 months.3Schlosser F.J. Gusberg R.J. Dardik A. Lin P.H. Verhagen H.J. Moll F.L. et al.Aneurysm rupture after EVAR: can the ultimate failure be predicted?.Eur J Vasc Endovasc Surg. 2009; 37: 15-22Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar Endoleaks are identified as the main cause of rupture.3Schlosser F.J. Gusberg R.J. Dardik A. Lin P.H. Verhagen H.J. Moll F.L. et al.Aneurysm rupture after EVAR: can the ultimate failure be predicted?.Eur J Vasc Endovasc Surg. 2009; 37: 15-22Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar This case is unique, because it is rare for a rupture of the aortic segment to occur between thoracic and aortic stents. Download .pptx (.39 MB) Help with pptx files Cover" @default.
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• W2089852964 date "2014-02-01" @default.
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• W2089852964 title "Hybrid repair of ruptured thoracoabdominal aortic aneurysm in a patient with previous endovascular abdominal aortic aneurysm repair and thoracic endovascular aneurysm repair" @default.
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• W2089852964 doi "https://doi.org/10.1016/j.jvs.2013.07.004" @default.
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