Advances in
abdominal aortic aneurysm (AAA) endograft device technology have contributed to improved outcomes and durability of endovascular
aortic aneurysm repair (EVAR), even in complex infrarenal aortic anatomies. However,
stent graft failure secondary to
endoleaks, migration, endotension and sac enlargement are persistent problems that can result in
aneurysm rupture following EVAR.A symptomatic infrarenal AAA (4mm proximal neck) was treated initially with an Ovation Prime™ device (TriVascular, Inc., Santa Rosa, CA) in an off-label fashion, leading to type Ia
endoleak moderately reduced by additional proximal neck ballooning. A failed Chimney technique to the single patent, but severely stenosed, right renal artery preceded the use of this device. A large type Ia
endoleak was evident at 6-month follow-up, but following a failed supplementary endovascular intervention with coils to seal the
endoleak, the patient presented with
hemorrhagic shock from AAA
rupture, requiring urgent open conversion. Intraoperatively it was impossible to explant this new type of endograft. Circumferential tying of the infrarenal aorta with a
Teflon band was unable to stop the
bleeding. However, after dividing the body of the
stent-graft below the two proximal
polymer rings, the
endoleak was successfully treated by suturing the graft with the proximal aortic neck. The procedure was completed with extension of the stump to the common femoral arteries using a bifurcated
Dacron prosthesis.The body of an Ovation Prime™ endograft may be impossible to explant in open conversion conditions. Large prospective studies with longer follow-up are required to adequately reflect the behavior of this particular device.