Disseminated intravascular coagulation in a patient after endovascular aneurysm repair due to symptomatic abdominal aortic and iliac artery aneurysm

Purpose: To evaluate the feasibility and safety of sac embolization with N-butyl cyanoacrylate (NBCA) in emergency endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) in comparison to EVAR without sac embolization. Materials and Methods: Between February 2012 and December 2019, among 44 consecutive patients with ruptured AAA or IAA, 29 underwent EVAR. Of these, 22 patients (median age 77.5 years; 18 men) had concomitant sac embolization using NBCA; the remaining 7 patients (median age 88 years; 6 men) underwent EVAR without sac embolization and form the control group. The technical success, clinical success (hemodynamic stabilization), procedure-related complications, and mortality were compared between the groups. Results: All EVAR procedures and embolizations were successful. The clinical success rates in the NBCA and control groups were 95% (21/22) and 71% (5/7), respectively (p=0.14). There was no complication related to the procedure. Type II endoleak occurred in 4 of 21 patients (19%) in the NBCA group vs none of the control patients. One patient (5%) died in the NBCA group vs 3 (43%) in the controls (p=0.034). Conclusion: Sac embolization using NBCA in emergency EVAR appears to be feasible and safe for ruptured AAA and IAA.

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Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4

Case Reports in Surgery ◽

10.1155/2016/8572950 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Saranat Orrapin ◽

Saritphat Orrapin ◽

Supapong Arworn ◽

Termpong Reanpang ◽

Kittipan Rerkasem

Keyword(s):

Abdominal Aortic Aneurysm ◽

Immune Status ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aneurysm ◽

Hiv Patients ◽

Iliac Artery Aneurysm ◽

Abdominal Aortic ◽

Aneurysm Repair

We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR) technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity.

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Aneurysm-related disseminated intravascular coagulation successfully treated by endovascular repair

Hematology Reports ◽

10.4081/hr.2019.8189 ◽

2019 ◽

Vol 11 (4) ◽

Cited By ~ 1

Author(s):

Miguel Lemos Gomes ◽

Alice Lopes ◽

Ana Parente Freixo ◽

Gonçalo Sobrinho ◽

Ruy Fernandes ◽

...

Keyword(s):

Aortic Aneurysm ◽

Disseminated Intravascular Coagulation ◽

Endovascular Aneurysm Repair ◽

Underlying Disease ◽

Abdominal Aneurysm ◽

Laboratory Findings ◽

Intravascular Coagulation ◽

Abdominal Aortic ◽

Internal Iliac ◽

Aneurysm Repair

Aortic abdominal aneurysm (AAA) is an uncommon etiology of disseminated intravascular coagulation (DIC). The authors report a case of an 81-year-old male patient who presented with hematuria, intraoral hemorrhage, melaenas and ecchymosis of the lower back and of the abdominal wall, after being medicated with etoricoxib for a back pain. During the study, an abdominal aortic aneurysm, which prolonged to the left common and internal iliac artery, was discovered. The diagnosis of AAA induced DIC was made. After endovascular aneurysm repair (EVAR), the patient’s hemorrhagic manifestations disappeared and the laboratory findings normalized. In conclusion, the state-of-the-art treatment of DIC is the elimination of the underlying disease; in this case, EVAR was proven to be effective in treating the aortic aneurysm and the AAA-related DIC.

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Endovascular aneurysm repair for an abdominal aortic aneurysm and a left ruptured common iliac artery aneurysm in a patient with hepatocellular carcinoma: report of a case

Surgery Today ◽

10.1007/s00595-013-0519-3 ◽

2013 ◽

Vol 44 (8) ◽

pp. 1548-1551 ◽

Cited By ~ 2

Author(s):

Ryoichi Kyuragi ◽

Takuya Matsumoto ◽

Jun Okadome ◽

Eisuke Kawakubo ◽

Kenichi Homma ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Common Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Iliac Artery Aneurysm ◽

Abdominal Aortic ◽

Common Iliac Artery Aneurysm ◽

Aneurysm Repair

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Internal Iliac Artery Branch Graft for Common Iliac Artery Aneurysm Following Previous Open Abdominal Aortic Aneurysm Repair

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2007.11.021 ◽

2008 ◽

Vol 35 (4) ◽

pp. 436-438 ◽

Cited By ~ 16

Author(s):

J. Naik ◽

P.D. Hayes ◽

U. Sadat ◽

T.C. See ◽

C. Cousins ◽

...

Keyword(s):

Iliac Artery ◽

Artery Aneurysm ◽

Abdominal Aortic Aneurysm Repair ◽

Iliac Artery Aneurysm ◽

Abdominal Aortic ◽

Internal Iliac ◽

Common Iliac Artery Aneurysm ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair ◽

Artery Branch

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Another Late Complication after Endovascular Aneurysm Repair: Aneurysmal Degeneration at the Iliac Artery Landing Site

Vascular ◽

10.2310/6670.2008.00065 ◽

2008 ◽

Vol 16 (6) ◽

pp. 316-320 ◽

Cited By ~ 6

Author(s):

Obekieze Agu ◽

Dee Boardley ◽

Mohan Adiseshiah

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Late Complication ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Landing Site ◽

Iliac Artery Aneurysm ◽

Aneurysm Formation ◽

Impending Rupture ◽

Aneurysm Repair

The purpose of this article is to describe a hitherto underreported late complication of infrarenal endovascular aneurysm repair (EVAR), namely type Ib endoleakage resulting from aneurysmal degeneration at the iliac artery landing site. In a prospectively recorded audit, between 1994 and 2007, 297 patients underwent EVAR. All cases that developed iliac artery aneurysm (IAA) were studied. Ten cases of IAA in seven patients (2.4% of the cohort) developed 5 to 9 years after EVAR. Eight of the 10 involved the lower landing site of the stent graft. Landing site diameter before EVAR was 12 mm (range 10–15 mm). Three IAAs presented as emergencies with rapidly expanding sacs and impending rupture. All cases underwent further endovascular intervention with no < 30-day mortality. Iliac artery landing site aneurysm formation after EVAR occurs uncommonly after 5 or more years. It should be regarded as an indication for intervention prior to type Ib endoleakage development. The need for lifelong surveillance is highlighted.

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Double D Technique: An Innovative Modified Bifurcated Stent Graft Deployment Strategy for an Isolated Common Iliac Artery Aneurysm With a Challenging Renal Artery Anatomy

Vascular and Endovascular Surgery ◽

10.1177/1538574419862671 ◽

2019 ◽

Vol 53 (7) ◽

pp. 613-616 ◽

Cited By ~ 1

Author(s):

Yusuke Date ◽

Tamaki Takano ◽

Taishi Fujii ◽

Takamitsu Terasaki ◽

Masayuk Sakaguchi

Keyword(s):

Renal Artery ◽

Iliac Artery ◽

Common Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Aortic Bifurcation ◽

Iliac Artery Aneurysm ◽

Common Iliac Artery Aneurysm ◽

The Right ◽

Aneurysm Repair

Purpose: Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. Case Report: An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. Conclusion: Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.

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Abdominal Aortic Disease: A Multicase Review

Journal for Vascular Ultrasound ◽

10.1177/1544316719829602 ◽

2019 ◽

Vol 43 (1) ◽

pp. 18-24

Author(s):

Joshua D. Lee ◽

Courtney Webb ◽

Mark W. Fugate

Keyword(s):

Patient Care ◽

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Disease Diagnosis ◽

Aortic Disease ◽

Type I ◽

Abdominal Aortic ◽

Type I Endoleak ◽

Vascular Laboratory

Abdominal aortic disease affects more than 3 million people per year. For vascular sonographers, imaging aortic disease can become routine. Therefore, it is necessary to expand the knowledge that we have of aortic disease, diagnosis, and treatment. We present 4 cases with new or worsening conditions diagnosed by duplex ultrasound (DUS). Our first case is a 79-year-old woman returning for surveillance of an endovascular aneurysm repair (EVAR). The DUS findings reveal an increasing abdominal aortic aneurysm (AAA) sac, with evidence of flow originating from an incomplete seal at the attachment suggesting type I endoleak. Next, is a 56-year-old man returning 1 month after type A dissection repair, now presenting with unilateral claudication. The DUS findings of the left lower extremity demonstrated an early systolic deceleration waveform, suggesting more proximal disease. Upon further imaging, an abdominal aortic dissection was identified terminating into the left internal iliac artery, causing the true lumen to be compressed. The third case was a 75-year-old man returning for follow-up of an EVAR and iliac repair. The DUS findings show an increase in iliac artery sac size and anechoic area that was filled with color Doppler flow. These findings are suggestive of type I endoleak involving the distal attachment. The last case is a 56-year-old man returning for EVAR and iliac artery repair surveillance. The common iliac artery aneurysm sac had increased in diameter and length. The distal attachment of the left iliac extension cuff terminated within the aneurysm sac, causing a type I endoleak. Accurate DUS diagnosis of aortic disease is crucial for patient care. Meticulous analysis of the vessels and surrounding structures can make a difference in diagnostic outcomes. Vascular sonographers should continually review and revise vascular laboratory protocols to increase their diagnostic accuracy and improve patient care. It is important to extend the vascular laboratory protocols when complex cases arise to better demonstrate complicated diagnoses and challenging anatomy.

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Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.0021 ◽

2014 ◽

Vol 13 (4) ◽

pp. 318-324

Author(s):

Rodrigo Gibin Jaldin ◽

Marcone Lima Sobreira ◽

Regina Moura ◽

Matheus Bertanha ◽

Jamil Víctor de Oliveira Mariaúba ◽

...

Keyword(s):

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Aneurysms ◽

Arterial Access ◽

Abdominal Aortic ◽

First Choice ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

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