Sac enlargement due to seroma after endovascular abdominal aortic aneurysm repair with the Endologix PowerLink device

Abstract

A patient who had undergone endovascular repair of an abdominal aortic aneurysm with the Endologix PowerLink bifurcated system presented with delayed aortic aneurysm enlargement due to assumed endotension. He was treated with aortic sac evacuation and wrapping of the endograft. This is the first report of endotension and aneurysm sac enlargement after implantation of the PowerLink endograft.

Symptomatic infrarenal aortic aneurysm sac expansion 5 years post‐endovascular repair without an identifiable endoleak

“…It is thought to relate to the permeability of the endograft material . It has been documented that an excluded aneurysm sac can undergo fibrinolysis either spontaneously or in response to over‐anticoagulation . This process leads to an increase in protein concentration within the now liquified haematoma because of fibrin degradation .…”

“…This process leads to an increase in protein concentration within the now liquified haematoma because of fibrin degradation . It is hypothesised that the oncotic pressure within the sac eventually rises enough to favour movement of fluid from passing blood into the aneurysm sac by ultrafiltration of plasma through the graft material, which behaves as a semipermeable …”

Endotension after endovascular treatment of abdominal aortic aneurysm: Percutaneous treatment

“…[10][11][12][13][14] In endotension, increased fibrinolysis inside the aneurysm sac was also found. 15,16 Cause of insufficient organization of thrombus can also be excessive anticoagulation treatment and it can be managed by correction of coagulation parameters and subsequent monitoring. 17 Management of endotension is still controversial.…”

“…11 Laparoscopic fenestration of the aneurysm sac with removal of all thrombotic material was also reported. 15,16 On the other side, some authors recommend to follow-up patients if the patients with endotension are not symptomatic, because they suppose eventual rupture will not be dramatic and fatal. 18 Nevertheless, increasing aneurysm sac size can lead to enlargement of landing zones, especially in proximal neck, and it can lead to migration or disintegration of stent graft and to type I or III of endoleak and subsequently to fatal rupture.…”

Conversion to Open Repair After Endografting for Abdominal Aortic Aneurysm: A Review of Causes, Incidence, Results, and Surgical Techniques of Reconstruction

“…Indeed, there are several reports of late conversion due to all types of endoleak. 7,19,30,31 Type I is the most commonly associated with late conversion in the literature, followed by ¤ ¤ Types I and III endoleaks have a tendency to rupture early and should be treated without delay. 32,33 Conversion to open surgery should be planned when the secondary endovascular procedure has failed.…”