Key result
Open surgical repair was successfully performed without complications in an 83-year-old man with a re-ruptured 18 cm giant abdominal aortic aneurysm caused by a type IA endoleak after previous EVAR.
Why the study?
Long-term outcomes of endovascular repair for ruptured abdominal aortic aneurysms are lacking, and few data have been published on the treatment of giant abdominal aortic aneurysms and ruptured abdominal aortic aneurysms.
Case Report (n=1)
This case highlights the importance of vascular surgeons maintaining proficiency in both open and endovascular techniques for managing complex ruptured abdominal aortic aneurysms.
Answers are grounded in this paper and cite their sources.
Supports dual open-endovascular proficiency for complex post-EVAR ruptures; leaves open generalizability from single case.
INTRODUCTION: Ruptured abdominal aortic aneurysms (AAAs) are known to be associated with high fatal outcomes. Giant AAAs are often defined as having a maximum diameter over 13 cm. Large AAAs over 8 cm have demonstrated a yearly rupture rate of 30-50%, which explains the rarity of giant AAAs. Endovascular repair of ruptured AAAs (rAAAs) is increasingly advocated because of the shorter hospital stay and fewer post-operative complications. Nonetheless, outcomes regarding mortality and cost-effectiveness show a large variability and long-term outcomes are lacking. Few data have been published on treatment of giant AAAs and rAAAs; however, open surgery is generally the preferred option. REPORT: An 83 year old presented to the Emergency Department with a history of ruptured abdominal aortic aneurysm treated with an aorto-uni-iliac endograft and a femorofemoral crossover bypass. During follow up, this was complicated by a symptomatic type III endoleak, which was treated by endovascular repair. During the current admission, he presented with a re-rupture of his former aneurysm, which now was 18 cm diameter because of a type IA endoleak. Open surgical repair was performed and the post-operative course was without complications. DISCUSSION: The current case underlines the value of vascular surgeons being able to perform both open and endovascular surgery in rAAA.
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Meekel et al. (2019) conducted a case report in Ruptured giant abdominal aortic aneurysm (n=1). Open surgical repair was evaluated on Post-operative course. Open surgical repair was successfully performed without complications in an 83-year-old man with a re-ruptured 18 cm giant abdominal aortic aneurysm caused by a type IA endoleak after previous EVAR.
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