Cor Vasa 2018, 60(5):e547-e550 | DOI: 10.1016/j.crvasa.2017.11.003

Surgical resection of occluded abdominal stent graft followed by aorto-bi-iliac vascular reconstruction with Intergard Synergy vascular prosthesis

Róbert Novotný^a,*, Petr Mitáš^a, Jaroslav Hlubocký^a, Zuzana Hlubocká^b, Jaroslav Lindner^a

^a II. chirurgická klinika kardiovaskulární chirurgie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha, Česká republika

^b II. interní klinika kardiologie a angiologie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha, Česká republika

Introduction: We are presenting a case report of an 82-year-old polymorbid patient treated with Aortofix AAA Flexible Stent Graft System for symptomatic 51 mm subrenal aortic aneurysm complicated with an early closure of the right stent graft branch resulting in a severe right lower extremity ischemia.

Method: Stent graft dissection and resection were performed trough midline laparotomy. Due to the severe calcifications of the supra- and sub-renal aorta, a Nucleus 25 mm balloon was inserted into the abdominal aorta instead of using an aortal cross-clamp. After the resection, aorto-bi-iliac revascularisation was performed with the use of Intergard Synergy 18/9 mm vascular prosthesis.

Results: Following the stent graft resection and surgical revascularisation, normal blood flow was restored into the affected lower extremity with no residual signs and symptoms of limb ischemia. The patient recovered without any further complications and was discharged on the fifth postoperative day.

Conclusion: When endovascular treatments of stent grafts' branch occlusion fail, surgical treatment, despite its higher perioperative risks and technical challenges, remains the only treatment option.

Keywords: Abdominal; Aneurysm; Aorta; Bypass; Iliac angulation; Occlusion; Resection; Stent graft

Received: May 4, 2017; Accepted: November 6, 2017; Published: October 1, 2018  Show citation