Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70–100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.
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References
1.
Dubost C, Allary M, Oeconomos N: Resection of an aneurysm of an abdominal aorta. Re-establishment of the continuity by a preserved human arterial graft, which results after 5 months. Arch Surg64:405-408, 1952.
May J, White GH, Yu W, et al: Treatment of complex abdominal aortic aneurysms by a combination of endoluminal and extraluminal aortobifemoral grafts. J Vasc Surg19:924-933, 1994.
4.
Chute R, Tam WG, Hopkinson BR, et al: Transfemoral insertion of a bifurcated endovascular graft for aortic aneurysm repair: The first 22 patients. J Cardiovasc Surg3:121-128, 1995.
5.
Hollier LA, Taylor LM Jr, Ochner J: Recommended indications for operative treatment of abdominal aortic aneurysms. J Vasc Surg15:1046-1056, 1992.
6.
Allen BT, Hovsepien DM, Reilly JM, et al: Endovascular stent grafts for aneurysmal and occlusive vascular disease and initial institutional experience. Am J Surg45:437-447, 1998.
7.
White GH, Yu W, May J, et al: Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: Classification, incidence, diagnosis, and management. J Endovasc Surg4:52-168, 1997.
8.
Katz BJ, Stanley JC, Zelenock GB: Operative mortality rates with intact and ruptured abdominal aortic aneurysms in Michigan: An 11-year statewide experience. J Vasc Surg19:804-817, 1994.
9.
Johnson KW: Multi-sensor prospective study of nonruptured abdominal aortic aneurysm, part II: Variable predicting morbidity and mortality. J Vasc Surg9:437-447, 1989.
10.
Sedwitz MM, Hye RJ, Freischlag JA, et al: Zero operative mortality in 109 consecutive elected aortic operations by residents. Surg Gynecol Obstet170: 385-389, 1990.
11.
White GH, May J, Waugh RC, et al: Type III and type IV endoleak: Toward a complete definition of blood flow in the sac after endoluminal AAA repair. J Endovasc Surgery5:305-309, 1998.
12.
Hallett JW Jr, Marshal J, Peterson TM, et al: Graft-related complication after abdominal aortic aneurysm repair: Reassurance from a 36-year population-based experience. J Vasc Surg25:277-286, 1997.
13.
Nasim A, Thompson MM, Sayers RD, et al: Is endoluminal abdominal aortic aneurysm repair using aortoaortic (tube) device a durable procedure?Ann Vasc Surg12:522-528, 1998.
14.
Gilling-Smith G, Brennan J, Harris P, et al: Endotension after endovascular aneurysm repair: Definition, classification, and strategies for surveillance and intervention. J Endovasc Surg6:305-307, 1999.
15.
Zarins CK, White RA, Schwarten D, et al: Aneurysm stent graft versus open surgical repair of abdominal aortic aneurysms: Multicenter prospective clinical trial. J Vasc Surg29:292-308, 1999.
16.
Sonesson B, Resch T, Lanne T, et al: The fate of the infrarenal aortic neck after open aneurysm surgery. J Vasc Surg28:889-894, 1998.
17.
Lipski DA, Ernest CB: Natural history of the residual infrarenal aorta after infrarenal abdominal aortic aneurysm repair. J Vasc Surg27:805-812, 1998.
18.
Mastsumura JS, Pearce WH, Cabellon A, et al: Reoperative aortic surgery. Cardiovasc Surg7:614-621, 1999.
19.
Plate G, Hollier LA, O'Brien P, et al: Recurrent aneurysms and late vascular complications following repair of abdominal aortic aneurysms. Arch Surg120:590-594, 1985.
20.
Matsumura JS, Chaikof EL, for the EVT investigators: Continued expansion of aortic necks after endovascular repair of abdominal aneurysms. J Vasc Surg28:422-431, 1998.
21.
Illig KA, Green RM, Quriel K, et al: Fate of the proximal aortic cuff: Implications for endovascular aneurysm repair. J Vasc Surg26:492-501, 1997.
22.
Panayiotopoulos YP, Sandison AJ, Reidy JF, et al: Endovascular repair of residual iliac artery aneurysms following surgery for ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg12:482-486, 1996.
23.
Yuan JG, Martin ML, Veith FJ, et al: Endovascular grafts for noninfected aortoiliac anastomotic aneurysms. J Vasc Surg26:210-221, 1997.
24.
Sultan S, Fulton G, Butcher W, et al: Transfemoral endoluminal aortic management (TEAM) versus open surgical repair (OR) in patients with infrarenal abdominal aortic aneurysms (AAA) who are suitable for both techniques. Technical and clinical outcome. Irish J Med Sci170(suppl 1):27-28, 2001.
25.
Sultan S, Purcell E, Evoy D, et al: Oversizing of the covered stent graft and suprarenal spare-springs are important in diminishing the incidence of endoleak in transfemoral endoluminal aortic management (TEAM) for infrarenal abdominal aortic aneurysms. Irish J Med Sci169:21-22, 2000.
26.
Sultan S, Evoy D, Nicholls S, et al: Endoluminal stent grafts in the management of infrarenal abdominal aortic aneurysms. A realistic assessment. Eur J Vasc Endovasc Surg21:1:70-74, 2001.
27.
Solis MM, Ayerdi J, Babcock GA, et al: Mechanism of failure in the treatment of type II endoleak with percutaneous coil embolization. J Vasc Surg36:485-491, 2002.
28.
Veith FJ, Baum RA, Ohki T, et al: Nature and significance of endoleaks and endotension: Summary of opinions expressed at an international conference. J Vasc Surg35:1029-1035, 2002.
29.
van Marrewijk C, Buth J, Harris PL, et al: Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience. J Vasc Surg35:461-473, 2002.
30.
Huber TS, Wang JG, Derrow AE, et al: Experience in the United States with intact abdominal aortic aneurysm repair. J Vasc Surg33:304-311, 2001.
May J, White GH, Yu W, et al: Concurrent comparison of endoluminal versus open repair in the treatment of abdominal aortic aneurysms: Analysis of 303 patients by life table method. J Vasc Surg27:213-221, 1998.
34.
May J, White GH, Waugh R, et al: Adverse events after endoluminal repair of abdominal aortic aneurysms: A comparison during two successive periods of repair using the AneuRx stent graft. J Vasc Surg31:960-970, 2000.
35.
Kalliatas S, Albertini J-N, Macierewicz J, et al: Incidence and treatment of intraoperative technical problems during endovascular repair of complex abdominal aortic aneurysms. J Vasc Surg31:1185-1192, 2000.
36.
Collin J, Murie JA: Endovascular treatment of abdominal aortic aneurysm: A failed experiment. Br J Surg88:1281-1282, 2001.
37.
Burks JA Jr, Faries PL, Gravereaux EC, et al: Endovascular repair of bleeding aortoenteric fistulas: A 5-year experience. J Vasc Surg34:1055-1059, 2001.
38.
Morrissey NJ, Yano OJ, Soundararajan K, et al: Endovascular repair of para-anastomotic aneurysms of the aorta and iliac arteries: Preferred treatment for a complex problem. J Vasc Surg33:503-512, 2001.
39.
McArthur C, Teodorescu V, Eisen L, et al: Histopathologic analysis of endovascular stent grafts from patients with aortic aneurysms: Does healing occur?J Vasc Surg33:733-738, 2001.
40.
Makaroun MS, Chaikof E, Naslund T, et al: Efficacy of a bifurcated endograft versus open repair of abdominal aortic aneurysms: A reappraisal. J Vasc Surg35:203-210, 2002.
