Small Ruptured Abdominal Aortic Aneurysm with Renal Failure: Endovascular Treatment

Abstract

The successful endovascular exclusion of a ruptured 3-cm diameter atherosclerotic abdominal aortic aneurysm (AAA) in a high-risk patient with renal failure is reported. An 82-year-old man with chronic renal failure and other comorbidities was admitted for acute abdominal pain. Duplex scan and computed tomography showed a ruptured 3-cm diameter atherosclerotic AAA. As a consequence of the patient's high surgical risk combined with signs of rupture, despite the progressively decreasing renal function, an emergency exclusion of the AAA was performed by means of a bifurcated Excluder (W. L. Gore and Associates) endovascular graft. The procedure was performed by minimizing administration of iodinated contrast medium using a guidewire into the lowest renal artery as a marker of proximal deployment. Intravascular ultrasound was used to confirm correct deployment. The postoperative recovery was characterized by acute renal insufficiency and bowel ischemia, which were treated with ultrafiltration and medical therapy, respectively, with complete resolution.

Get full access to this article

View all access options for this article.

References

1. Halpern VJ , Kline RG , D'Angelo AJ , et al: Factors that affect the survival rate of patients with ruptured abdominal aortic aneurysms. J Vasc Surg 26:939-948, 1997.

2. Sheneider ALJ : Assessment of risk factors and surgical outcome. Surg Clin North Am 63:1113-1113, 1983.

3. Noel AA , Gloviczki P , Cherry KJ , et al: Ruptured abdominal aortic aneurysms: The excessive mortality of conventional repair. J Vasc Surg 34:41-46, 2001.

4. Ohki T , Veith FJ , Sanchez LA , et al: Endovascular graft repair of ruptured aortoiliac aneurysms. J Am Coll Surg 189:102-113, 1999.

5. Hinchliffe RJ , Yusuf SW , Macierewicz JA , et al: Endovascular repair of ruptured abdominal aortic aneurysm-a challenge to open repair? Results of a single centre experience in 20 patients. Eur J Vasc Endovasc Surg 22:528-534, 2001.

6. Panneton JM , Lassonde J , Laurendeau F : Ruptured abdominal aortic aneurysms: Impact of comorbidity and postoperative complications on outcome. Ann Vasc Surg 9:535-541, 1995.

7. Ouriel K , Geary K , Grenn RM , et al: Factors determining survival after ruptured aortic aneurysm: The hospital, the surgeon, and the patient. J Vasc Surg 11:493-496, 1990.

8. Darling RC , Cordero JA , Chan BB : Advances in surgical repair of ruptured abdominal aortic aneurysms. Cardiovasc Surg 4:720-723, 1996.

9. Dardik A , Burleyson GP , Bowman H , et al: Surgical repair of ruptured aortic aneurysms in the state of Maryland: Factors influencing outcome among 527 recent cases. JVasc Surg 28:413-421, 1998.

10.

10. Carpenter JP , Fairman RM , Barker CF , et al: Endovascular AAA repair in patients with renal insufficiency: Strategies for reducing adverse renal events. Cardiovasc Surg 9:559-564, 2001.

11.

11. Irshad K , Reid DB , Miller PH , et al: Early clinical experience with color three-dimensional intravascular ultrasound in peripheral interventions. J Endovasc Ther 8:329-338, 2001.

12.

12. Fletcher J , Saker K , Batiste P : Colour Doppler diagnosis of perigraft flow following endovascular repair of abdominal aortic aneurysm. Int Angiol 19:326-330, 2000.

13.

13. Powell JT , Brown LC : The natural of abdominal aortic aneurysm and their risk of rupture. Act Chir Belg 101:11-16, 2001.

14.

14. Miller J , Miller J : Small ruptured abdominal aneurysm diagnosed by emergency physician ultrasound. Am J Med 17:174-175, 1999.