A Case of Double D Technique for Ruptured Left Common Iliac Artery Aneurysm

Abstract

A 77-year-old man was referred to our hospital for evaluation of abdominal pain of acute onset and was diagnosed with a ruptured left common iliac artery aneurysm based on contrast-enhanced computed tomography findings. Although the distance between the inferior renal artery and the aortic bifurcation was short (55 mm) and outside the instruction for use (IFU), we performed endovascular aortic repair (EVAR) using the Double D Technique (DDT). No endoleak was observed; however, the patient developed abdominal compartment syndrome, 4 hours postoperatively and underwent open decompression. We performed retroperitoneal hematoma removal and closure on the second postoperative day. On the third postoperative day, we observed a Type Ib endoleak in the left limb of the endograft, secondary to intraoperative manipulation during retroperitoneal hematoma removal, and a stent graft was deployed. The patient did not show an endoleak thereafter. EVAR is increasingly being performed for ruptured abdominal aortic aneurysms and is considered the first-choice treatment in patients with anatomical suitability for the procedure. EVAR is less invasive than open surgery with reportedly comparable or better outcomes; therefore, utilization of EVAR is expected to increase in the future. DDT is a useful therapeutic alternative for cases of rupture outside of IFU.