Abstract
A 75-year-old male was transferred to a local hospital due to loss of consciousness (LOC). Contrasted computer tomography (CT) revealed the ruptured abdominal aortic aneurysm and retroperitoneal hematoma with the severity of Type 3 in Fitzgerald’s classification. He was transferred to our hospital, and presented with hemorrhagic shock upon the arrival. A low level of prognosis was predicted by the presence of two Hardman’s factors (Hgb<7.7 g/dl and LOC). Suprarenal balloon aortic occlusion (BAO) was set up urgently, emergency EVAR was performed using Excluder (W. L. Gore & Associates, Az). The hemodynamics was stabilized temporarily, but an hour later, he went into shock again presenting with abdominal compartment syndrome (ACS). Contrasted CT showed further extension of retroperitoneal hematoma and exudation of contrast agent into the abdominal cavity in the early arterial phase. Resetting BAO, abdominal incision was performed urgently to drain the large volume of hemorrhagic ascites. After fastening a banding tape around the proximal landing zone of the stent graft, we incised into the aneurysm, and stopped back-bleeding of lumber arteries surgically. The right contralateral leg was removed, and lumber and sacral arteries originated from the right common iliac artery (RCIA) were sewn closed. A bypass from the contralateral gate of the stent-graft to the RCIA was constructed using a Dacron graft. He survived postoperative multi organ dysfunction and was discharged after 36 postoperative days without complication.
