Download PDF
CC BY 4.0 · Aorta (Stamford) 2020; 08(04): 098-103
DOI: 10.1055/s-0040-1714123
Original Research Article

Aortic Rupture during Endovascular Aneurysm Repair. Report of Our Experience and Review of the Literature

Konstantinos G. Moulakakis 
1   Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
,
Andreas M. Lazaris
1   Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
,
John D. Kakisis
1   Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
,
George S. Sfyroeras 
1   Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
,
George Theocharopoulos
1   Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
,
Andreas I. Panagiotopoulos
1   Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
,
Nikolas Krinos 
1   Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
,
George Geroulakos
1   Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background Aortic neck wall rupture during endovascular repair of abdominal aortic aneurysms (EVAR) is an underreported potentially fatal complication. Only a few cases have been reported. The main cause of this complication is repeated attempts at balloon inflation or overdilation to treat an intraoperative Type 1a endoleak. We report three cases complicated by procedure-related aortic neck wall rupture during EVAR. We also review the literature regarding the causes and outcomes of this complication.

Methods Medical records of all patients undergoing EVAR between January 2009 and March 2019 were retrospectively reviewed.

Results Overall, 824 EVAR procedures were performed, and rupture of the aortic neck wall was observed in three patients. In all cases, a Type 1a endoleak was observed and, in all cases, repeated ballooning attempts had been performed to resolve the endoleaks. In all cases, conversion to open repair was performed and all patients survived.

Conclusion In cases of Type 1a endoleak, a maximum of two ballooning attempts should be performed even if a Type 1a endoleak persists. In case of intraoperative aortic neck wall rupture, control of the hemorrhage should be achieved immediately by advancing the balloon above the site of rupture. Emergency surgical conversion in case of hemodynamic stability is the first choice. According to the literature, emergency surgical conversion, especially in cases of endograft with suprarenal fixation, is associated with significant morbidity and mortality rates, mainly due to hemorrhage and to the length of the procedure required to repair the aortic neck wall injury.

Keywords

EVAR - intraoperative - aortic rupture - open conversion - acute conversion


Publication History

Received: 07 August 2019

Accepted: 30 May 2020

Article published online:
11 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Chaikof EL, Dalman RL, Eskandari MK. et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67 (01) 2-77.e2
    CrossrefPubMedGoogle Scholar
  • 2 O'Donnell TFX, Corey MR, Deery SE. et al. Select early type IA endoleaks after endovascular aneurysm repair will resolve without secondary intervention. J Vasc Surg 2018; 67 (01) 119-125
    CrossrefPubMedGoogle Scholar
  • 3 Newton III WB, Shukla M, Andrews JS. et al. Outcomes of acute intraoperative surgical conversion during endovascular aortic aneurysm repair. J Vasc Surg 2011; 54 (05) 1244-1250 , discussion 1250
    CrossrefPubMedGoogle Scholar
  • 4 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 (06) 694-702
    CrossrefPubMedGoogle Scholar
  • 5 Moulakakis KG, Kakisis JD, Geroulakos G. Aortic banding to treat simultaneously a type Ia endoleak and aortic neck rupture during endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 2019; 61: 455-458
    CrossrefPubMedGoogle Scholar
  • 6 Fernandez JD, Craig JM, Garrett Jr HE, Burgar SR, Bush AJ. Endovascular management of iliac rupture during endovascular aneurysm repair. J Vasc Surg 2009; 50 (06) 1293-1299 , discussion 1299–1300
    CrossrefPubMedGoogle Scholar
  • 7 Schlösser FJ, Gusberg RJ, Dardik A. et al. Aneurysm rupture after EVAR: can the ultimate failure be predicted?. Eur J Vasc Endovasc Surg 2009; 37 (01) 15-22
    CrossrefPubMedGoogle Scholar
  • 8 Lee HY, Do YS, Kim YW. et al. Vascular rupture caused by a molding balloon during endovascular aneurysm repair: case report. J Korean Soc Radiol 2011; 65: 127-131
    CrossrefPubMedGoogle Scholar
  • 9 Jimenez JC, Moore WS, Quinones-Baldrich WJ. Acute and chronic open conversion after endovascular aortic aneurysm repair: a 14-year review. J Vasc Surg 2007; 46 (04) 642-647
    CrossrefPubMedGoogle Scholar
  • 10 Verzini F, Cao P, De Rango P. et al. Conversion to open repair after endografting for abdominal aortic aneurysm: causes, incidence and results. Eur J Vasc Endovasc Surg 2006; 31 (02) 136-142
    CrossrefPubMedGoogle Scholar
  • 11 Arthurs ZM, Lyden SP, Rajani RR, Eagleton MJ, Clair DG. Long-term outcomes of Palmaz stent placement for intraoperative type Ia endoleak during endovascular aneurysm repair. Ann Vasc Surg 2011; 25 (01) 120-126
    CrossrefPubMedGoogle Scholar
  • 12 Reyes Valdivia A, Beropoulis E, Pitoulias G. et al. Multicenter Registry about the use of EndoAnchors in the endovascular repair of abdominal aortic aneurysms with hostile neck showed successful but delayed endograft sealing within intraoperative type Ia endoleak cases. Ann Vasc Surg 2019; 60: 61-69
    CrossrefPubMedGoogle Scholar
  • 13 Pitoulias GA, Valdivia AR, Hahtapornsawan S. et al. Conical neck is strongly associated with proximal failure in standard endovascular aneurysm repair. J Vasc Surg 2017; 66 (06) 1686-1695
    CrossrefPubMedGoogle Scholar
  • 14 Karkos CD, Mitka M, Pliatsios I. et al. Rupture after previous endovascular aneurysm repair due to type IA endoleak: complete endograft preservation is feasible with proximal suturing, aortic neck banding, and sac plication. Ann Vasc Surg 2018; 49: 317.e5-317.e8
    CrossrefPubMedGoogle Scholar