Endovascular repair of a symptomatic aneurysm 5 years after AneuRx exclusion: off-label use of reversed talent aortomonoiliac stent-grafts.

Abstract

PURPOSE:

To describe the off-label use of 2 Talent aortomonoiliac devices to repair a symptomatic 72-mm abdominal aortic aneurysm (AAA) 5 years after AneuRx repair in a patient who had no follow-up.

CASE REPORT:

A 68-year-old man was referred to our hospital with a history of severe abdominal and back pain for 3 days. Five years earlier, he received an AneuRx stent-graft for an asymptomatic 51-mm infrarenal AAA, but he had not appeared for scheduled follow-up examinations. Computed tomographic angiography (CTA) showed a 72-mm AAA with bilateral common iliac aneurysms of 25 and 24 mm, respectively. The aortic segment of the AneuRx stent-graft appeared to be migrated distally by at least 20 mm; however, no type I endoleak was visible. Both distal iliac ends of the AneuRx stent-graft were migrated proximally and appeared to be floating free in the aneurysm sac, causing a bilateral type I endoleak distally. At operation, a 28-mm Talent aortic extension was inserted and dilated to cover the proximal migration zone. A Talent 28x16x126-mm aortomonoiliac stent-graft was reversed, re-installed into the deployment device, and deployed into the right AneuRx limb. The same procedure was followed on the left side, with deployment of a reversed 26x16x126-mm aortomonoiliac device. Angiography showed a fully excluded aneurysm with good anchoring of both stent-grafts. The patient was discharged on the third postoperative day in good general condition, without evidence of endoleak. At 3 and 6 months, CTA demonstrated no change in the position of the stent-graft and no signs of endoleak.

CONCLUSION:

The off-label use of a reversed aortomonoiliac stent-graft is an easy alternative to the well-known technique of a distally placed aortic extension cuff and also eliminates the risk of a type III endoleak.

• Authors: Joep A W Teijink, Robert F Lim
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 13 Issue 4 Pg. 501-4 (Aug 2006) ISSN: 1526-6028 [Print] United States
• PMID: 16928165 (Publication Type: Case Reports, Journal Article)

Topics

• Angiography
• Aorta, Abdominal (diagnostic imaging, surgery)
• Aortic Aneurysm, Abdominal (diagnostic imaging, surgery)
• Blood Vessel Prosthesis (adverse effects)
• Blood Vessel Prosthesis Implantation (methods)
• Foreign-Body Migration (diagnostic imaging, surgery)
• Humans
• Iliac Artery (diagnostic imaging, surgery)
• Male
• Middle Aged
• Postoperative Complications (diagnostic imaging, surgery)
• Prosthesis Failure
• Reoperation
• Stents (adverse effects)