Aorta Rupture Due to Extracorporeal Shock Wave Lithotripsy: A Rare Case Report

Since the 1980s, extracorporeal shock wave lithotripsy (ESWL) has been the treatment of choice for most urinary calculi. It is generally considered a safe method with a few complications involving the vascular system, among others. There are only a few literature reports of aortic rupture after ESWL and these mainly concern abdominal aortic aneurysms and rarely, severe atherosclerotic aorta. We report the case of a 67-year-old man with a rupture of a longitudinally and circumferentially calcified abdominal aorta and pseudoaneurysm formation following ESWL which he underwent a few days before the symptoms started. He reported urgently to our department after a recurrence of severe abdominal and lumbar pain. An endovascular treatment attempt with stent graft implantation was made initially but since the perforation did not seal, open surgery with stent removal, hematoma excision, and an aortobifemoral bypass was decided. He died 23 days later because of acute myocardial infarction. We believe that it is possible for severely calcified vessels to rupture through ESWL, and great care should be taken in these patients for symptoms or signs of retroperitoneal hematoma after the procedure.