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Acute type A dissection causing impending rupture of abdominal aortic aneurysm previously treated with EVAR. Annals of vascular surgery Ogawa, Y., Watkins, A. C., Lee, A., Iwakoshi, S., Dua, A., Pedroza, A. J., Dake, M. D., Lee, J. T. 2019

Abstract

This report describes the rapid expansion of a previously excluded abdominal aortic aneurysm (AAA) following type A aortic dissection repair in a 74-year-old male. Following successful hemi-arch replacement, CT angiography (CTA) showed residual dissection throughout the thoracoabdominal aorta which had created a proximal endoleak at the prior endovascular stentgraft resulting in rapid growth of the residual AAA sac. Urgent thoracic endovascular aortic repair (TEVAR) did not fully obliterate false lumen flow allowing further unstable expansion of the AAA and abdominal pain. This was ultimately managed with an open replacement of the infrarenal neck with a Dacron interposition graft sewn to the prior EVAR. Post-op CTA showed resolution of the false lumen communication to the infrarenal AAA and no further endoleak. Open interposition AAA neck replacement is a possible treatment for new onset endoleak in patients with aortic dissection following prior infrarenal EVAR.

View details for DOI 10.1016/j.avsg.2019.11.047

View details for PubMedID 31863952