2018 Volume 27 Issue 5 Pages 381-384
The patient was a male in his 60s. He underwent abdominal endovascular aortic repair (EVAR) four years ago. Due to a type II endoleak from the inferior mesenteric artery (IMA) and lumbar artery, we carried out four intravascular coil embolizations but the endoleak still remained. Due to a prominent complication of polycystic kidney and hepatic cysts in addition to a difficult ventrotomy, a watch and wait approach was taken, with a rupture occurring during the follow-up. We performed surgery to save his life. We cut open the aneurysm and confirmed bleeding from the lumbar arteries as the cause of the endoleak, then put in a suture to stop the bleeding. Because the right leg of the stent graft easily fell out, we controlled the bleeding by placing an occlusion balloon in the descending aorta in advance. The indwelling stent graft was preserved, so we carried out reconstruction by interposing new artificial blood vessels in both legs of the stent graft, respectively. In some cases, saving the life of the patient due to rupture after EVAR may be difficult. We hereinafter reported on a case in which we gave some consideration to the procedure and managed to save the life of the patient.
