Graft Replacement of an Abdominal Aortic Aneurysm Previously Treated by Endovascular Stent Grafting in Two Cases

(Department of Thoracic and Cardiovascular Surgery and Division of Traumatology and Critical Care Medicine*, Sapporo Medical University, Sapporo, Japan)

Toshiro Ito Nobuyoshi Kawaharada Yoshihiko Kurimoto*
Kenji Kuwaki Ryou Harada Yousuke Kuroda
Kiyohumi Morishita Tetsuya Higami
Ninety patients with abdominal aortic aneurysm underwent endovascular stent grafting in our hospital between 2001 and 2006 and two patients required graft replacement of abdominal aortic aneurysms during the late postoperative phase. Case 1 was a 77-year-old man for whom endovascular stent grafting for an abdominal aortic aneurysm and thoracic aortic aneurysm had been performed concomitantly. Six months later, because the abdominal aortic aneurysm had expanded from 68mm to 75mm in diameter, due to a type I endoleak which was detected postoperatively, he underwent open surgery. An occlusion balloon was inflated at the proximal site of the celiac artery until the stent graft was extracted. After positioning the aortic clamp below the origin of the renal arteries, a bifurcated graft was implanted. The postoperative course was uneventful. Case 2 was an 86-year-old woman who had undergone endovascular stent grafting for an abdominal aortic aneurysm. The endovascular procedure was successful and no endoleak was detected postoperatively. However, 13 months later, a community hospital admitted her in a state of shock due to ruptured abdominal aortic aneurysm. She was transferred to our hospital and underwent an emergency operation. Because insertion of an occlusion balloon into the brachial artery failed, we primarily performed supravisceral aortic cross clamping. After opening the aneurysm sac, the stent graft was removed and a bifurcated graft was implanted. After declamping, we found that the right common iliac artery was occluded, and therefore aorto-right external iliac bypass grafting was then also performed. The postoperative course was uneventful.
@Jpn. J. Cardiovasc. Surg. 36: 141-144i2007)