No abstract

Endoleaks, defined as blood flow outside the graft but inside the aneurysm sac, are a common complication after endovascular aneurysm repair. Sometimes however, for reasons not fully understood, expansion of the aneurysm sac can occur with no identifiable endoleak, a phenomenon termed endotension, or a type V endoleak. We describe a case of endotension in a 71-year-old man that developed after recurrent stent graft thrombosis requiring thrombolysis 3 years after the initial endovascular implantation. To our knowledge, this is the first description in the literature of endotension after multiple rounds of thrombolytic treatment.

Thoracoabdominal aortic aneurysms can require custom designed branched stent‐grafts. Visceral and renal artery orientations can change as more of this segment becomes aneurysmal. This study's purpose was to determine these orientations in infrarenal aneurysms as a baseline to compare to more complex proximal aneurysms. Aquarius TeraRecon 3D imaging software was used for morphological assessment of CT scans for 20 Infrarenal aneurysms. (15M, 5F, mean age=73.7). Four take off angles were measured. The clock‐face position (CFP) was noted in transverse sections for each. The direction of take off of the renal arteries was assessed (anterior, orthogonal and posterior) and maximal aortic aneurysm diameter was taken. The average take off angle was 63.06° in the Left Renal (LRA), 55.57° in the Right Renal (RRA), 60.07° in the Superior Mesenteric (SMA) and 56.82° in the Celiac Trunk (CT). The mode for CFP was 3:00 (n=8) in LRA, 10:00 (n=10) in RRA, 1:00 (n=9) in SMA and 1:00 (n=8) in CT. The mode for direction of take off angle was orthogonal (n=10) for LRA and anterior (n=12) for RRA. The mean maximal aneurysmal diameter was 57.95mm. The data suggests little variability in patients with Infrarenal aneurysms. This information will be used as a baseline as more proximal aneurysms are assessed.Grant Funding Source: Departmental

Re-intervention on abdominal aortic aneurysm treated by endovascular aortic aneurysm repair for complications such as endoleak, graft migration, and graft failure is relatively common. However, re-do endovascular aortic aneurysm repair can be complex, as the failed graft still resides within the vessel. In addition, some re-do endovascular aortic aneurysm repairs call for an advanced custom graft, which can further increase the complexity and technical skill required. We describe a case of a 15-year-old endovascular aortic aneurysm repair originally implanted in a 71-year-old man, followed by three separate complications requiring intervention. We describe important procedural decisions taken into consideration when presented with failure of an older graft.