2007 Volume 16 Issue 2 Pages 55-58
A 78-year-old man was referred with rupture of an abdominal aortic aneurysm. He had undergone a bifurcated stent graft implantation for the abdominal aortic aneurysm 5 years previously because of respiratory insufficiency resulting from old tuberculosis and right thoracoplasty. Although a type I endoleak from the proximal portion had been detected, additional treatment was not indicated because of his poor general condition. He suddenly complained of strong back pain, and emergency computed tomography revealed the abdominal aortic aneurysm and a massive hematoma in the retroperitoneal space. Emergency surgery was performed under a diagnosis of ruptured abdominal aortic aneurysm. He fell into shock soon after the initiation of general anesthesia, and prompt laparotomy was followed by cardiopulmonary resuscitation. The systemic arterial pressure increased to 80 mmHg after cross clamping just distal to the renal artery. The previous stent was extracted and graft replacement was successfully carried out. Although his respiratory insufficiency necessitated temporary tracheotomy, he survived without a major disability and returned home 51 days after the operation. Stent grafting has been widely applied especially for poor risk patient. Surgical treatment or additional stent implantation are indicated if an endoleak is detected.
