Acute Type A Dissection Causing Impending Rupture of Abdominal Aortic Aneurysm Previously Treated with EVAR

Yukihisa Ogawa, A. Claire Watkins, Anson Lee, Shinichi Iwakoshi, Anahita Dua, Albert J. Pedroza, Michael D. Dake, Jason T. Lee

Research output: Contribution to journalArticlepeer-review

Abstract

This report describes the rapid expansion of a previously excluded abdominal aortic aneurysm (AAA) following type A aortic dissection repair in a 74-year-old male. Following successful Hemiarch replacement, CT angiography (CTA) showed residual dissection throughout the thoracoabdominal aorta, which had created a proximal endoleak at the prior endovascular stent graft resulting in the rapid growth of the residual AAA sac. Urgent thoracic endovascular aortic repair (TEVAR) did not fully obliterate false lumen flow allowing further unstable expansion of the AAA and abdominal pain. This was ultimately managed with an open replacement of the infrarenal neck with a Dacron interposition graft sewn to the prior EVAR. Postoperative CTA showed resolution of the false lumen communication to the infrarenal AAA and no further endoleak. Open interposition AAA neck replacement is a possible treatment for new-onset endoleak in patients with aortic dissection following prior infrarenal EVAR.

Original languageEnglish (US)
Pages (from-to)289.e7-289.e11
JournalAnnals of Vascular Surgery
Volume65
DOIs
StatePublished - May 2020

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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