John K. Politz, MD, Virginia S. Newman, MD, Mark T. Stewart, MD

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Presentation transcript:

Late abdominal aortic aneurysm rupture after AneuRx repair: A report of three cases John K. Politz, MD, Virginia S. Newman, MD, Mark T. Stewart, MD Journal of Vascular Surgery Volume 31, Issue 3, Pages 599-606 (March 2000) DOI: 10.1067/mva.2000.105612 Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Noncontrast CT scan showing AAA with intraluminal device. Note the retroperitoneal hematoma contiguous with the aneurysm. Journal of Vascular Surgery 2000 31, 599-606DOI: (10.1067/mva.2000.105612) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Explanted AneuRx device with ex vivo dissection. A, Penmarks indicate anatomic endograft orientation. White paper insert demonstrates disengaged left iliac limb. B, Enlarged view of disengaged limb shows lack of fabric overlap of graft components. Note the acute fresh thrombus overlying the graft separation zone. This is the site of acquired Type III endoleak. White paper insert contrasts the stent graft fabric and surrounding thrombus. Journal of Vascular Surgery 2000 31, 599-606DOI: (10.1067/mva.2000.105612) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 AneuRx graft, which has become angulated because of longitudinal aneurysm shortening. Note the anterior bowing of the stent graft. The modular junction forms the apex of the bow and the point of graft separation, endoleak, and rupture. Journal of Vascular Surgery 2000 31, 599-606DOI: (10.1067/mva.2000.105612) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Three sets of radiopaque limb markers are seen. The most inferior marks designate the top of the iliac limb. These markers should reside between the other two sets of markers. Note the inferior displacement. Journal of Vascular Surgery 2000 31, 599-606DOI: (10.1067/mva.2000.105612) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Contrast CT scan before AneuRx repair. B, Contrast CT scan 12 months after AneuRx repair. Note lack of change in aneurysm diameter. C, Contrast CT scan showing large retroperitoneal hematoma extending superiorly beyond the body and proximal extension of graft. This image demonstrates a 2.5-cm increase in AAA size at an 11-month interval and aneurysm rupture. D, Contrast CT scan 6 months after open repair and stent graft explantation. Journal of Vascular Surgery 2000 31, 599-606DOI: (10.1067/mva.2000.105612) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Contrast CT scan of Patient 3 at 23 months after endograft implantation. Note large retroperitoneal hematoma and extensive contrast extravasation into the abdomen. Aneurysm size is approximately 7 cm in AP dimension. Journal of Vascular Surgery 2000 31, 599-606DOI: (10.1067/mva.2000.105612) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions