Abstract
An 82-year-old man with a history of knitted Dacron graft replacement for abdominal aortic aneurysm 13 years previously presented with abdominal pain. Computed tomography (CT) revealed multiple extravasation from the Dacron graft and false aneurysm, and angiography showed four extravasation points at the body (non-anastomotic lesion) and the legs (non-anastomotic or anastomotic lesions) of the Dacron graft. Because the patient had undergone laparotomy twice with a stoma formation, endovascular aneurysm repair (EVAR) was taken into consideration. A Zenith iliac plug was placed into the Dacron graft via the right femoral artery, followed by an aortic converter inserted from the left femoral artery. Finally, femorofemoral crossover bypass was performed to supply the adequate blood flow to the right leg. Although his symptom disappeared after this operation, delayed-phase CT images demonstrated type Ib or type III endoleak with no signs of progressive dilatation of the false aneurysm. The patient has been strictly followed on the outpatient clinic over 11 months postoperatively. Non-anastomotic false aneurysm is rare and EVAR using ancillary components such as converter and iliac plug may be an effective and less invasive surgical option even if typical EVAR is not applicable because of some anatomical restrictions.
