Repair of a Contained Ruptured Paravisceral Aortic Aneurysm Using a Surgeon-Modified Fenestrated Endograft and Development of an Aortogastric Fistula

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• 作者：Franziska Heidemann¹ ; ^{f.heidemann@uke.de" class="auth_mail" title="E-mail the corresponding author} ; Holger Diener¹ ; Sebastian Debus¹ ; Daniel Perez² ; Tilo Kö ; lbel¹ ; Nikolaos Tsilimparis¹
• 刊名：Annals of Vascular Surgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：294.e13-294.e17
• 全文大小：1147 K

文摘

Complex aortic aneurysms such as paravisceral aneurysm represent a challenging condition especially in the case of rupture. The presence of an aortoenteric fistula in this setting is associated with a very high mortality and morbidity. We report the case of a 72-year-old patient with contained ruptured paravisceral aortic aneurysm who underwent surgeon-modified fenestrated endovascular aneurysm repair (sm-fEVAR) with fenestrations for multiple renal arteries and the superior mesenteric artery. The patient successfully recovered from the repair but developed an aortogastric fistula on the basis of a preexisting gastric ulceration so that second-stage atypical gastrectomy was conducted. The further postoperative course was complicated by severe pancreatitis and sepsis resulting in multiorgan failure and in-hospital death 1.5 months later. We were able to demonstrate the technical feasibility of an sm-fEVAR for a contained ruptured paravisceral aneurysm. Coverage of the celiac artery is required in some complex cases but may lead to severe ischemic complication despite from angiographic sufficient collateralization.