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Porcine Model of Infrarenal Abdominal Aortic Aneurysm
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Collapsed bifurcated modular infrarenal endograft.

Animesh Rathore1, Peter Gloviczki2, Gustavo S Oderich2

  • 1Department of Surgery, Sentara Norfolk General Hospital, Norfolk, Va.

Journal of Vascular Surgery
|March 30, 2019
PubMed
Summary

Bilateral acute limb ischemia is a rare complication following endovascular aneurysm repair. This case highlights endograft collapse and thrombosis, necessitating complex surgical intervention.

Keywords:
Abdominal aortic aneurysmAcute limb ischemiaEndograft collapseEndograft infoldingEndovascular repair

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Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Aortic Aneurysm Repair

Background:

  • Endovascular Aneurysm Repair (EVAR) is a minimally invasive procedure for abdominal aortic aneurysms.
  • Complications, though rare, can be severe and require prompt management.

Observation:

  • A 70-year-old male developed bilateral acute limb ischemia 14 days post-EVAR for a large infrarenal abdominal aortic aneurysm.
  • The complication was attributed to endograft collapse and thrombosis of a GORE EXCLUDER device.

Findings:

  • The patient required emergency axillobifemoral bypass, fasciotomies, and eventual endograft removal with open repair.
  • Potential contributing factors included graft oversizing due to anatomical challenges: conical neck, bird-beak configuration, and tortuosity.

Implications:

  • This case underscores the critical importance of meticulous graft selection and sizing in EVAR.
  • Complex anatomy poses a significant risk for endograft-related complications such as infolding and collapse.
  • Early recognition and aggressive management are crucial for limb salvage in such rare scenarios.