2018 Volume 27 Issue 2 Pages 87-90
A 72-year-old female underwent thoracic endovascular aortic repair using the VALIANT endograft (Medtronic, Santa Rosa, CA, USA) and axillo-axillary bypass for saccular distal arch aortic aneurysm 2 years previously. Postoperative CT revealed no endoleak, but aneurysm sac enlargement had continued. The patient was scheduled to undergo open surgery, but she experienced left chest pain 2 months before surgery and enhanced CT showed a ruptured aneurysm. We therefore performed distal aortic arch repair by thoracotomy. Though there was a fingertip-sized hole and continuous oozing at the top of the aneurysm sac at the larger curvature, there was no endoleak, even during surgery. We diagnosed endotension-induced aneurysm sac rupture. Endotension is considered a continued expansion of the sac without leak with graft porosity contributing to aneurysm sac enlargement. Aneurysm sac rupture by endotension is not rare, and strict observation and addition of early endovascular treatment are useful strategies.
