A Case of an Enlarged Abdominal Aortic Aneurysm due to Type II Endoleak after EVAR which Required Open Surgery

Abstract

A 77-year-old man had undergone endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA) 47 mm in diameter and a left common iliac aortic aneurysm at another hospital in April 2010. During the operation, type II endoleak was confirmed. Thereafter yearly follow-up CT scanning had been conducted in our hospital. Enlargement of the AAA up to 73 mm in diameter was noted in July 2013. He was referred to our department for the purpose of surgery. Laparotomy was performed by the abdominal midline incision, and the thick lumbar artery, inferior mesenteric artery and left internal iliac artery which might cause type II endoleak were ligated from the outside of the aneurysm. After the central and peripheral sides of the stent grafts were taped and snared, the AAA and the left common iliac arterial aneurysm were incised. We confirmed retrograde blood flow from the lumbar artery into the aneurysm sac, so that we performed hemostasis by sutures and plication suture for the aneurysms.
Taping and snaring of the central and peripheral sides of stent grafts is a useful method which can prevent from hemorrhage due to migration of the stent graft by surgical procedure of latent type I endoleak.