Concealed Descending Aortic Rupture with Direct Stent Graft Repair: Open Salvage of Endoleaks

P0089 

Case Video Submission 

Jacky Yan Kit Ho (1), Kevin Lim (1), Chi Ying Simon Chow (1), Takuya Fujikawa (1), Randolph Wong (1)

(1) Prince of Wales Hospital, Hong Kong SAR, Hong Kong SAR

Jacky Yan Kit Ho    -  Contact Me
Prince of Wales Hospital, Hong Kong SAR

Kevin Lim    -  Contact Me
Prince of Wales Hospital, Hong Kong SAR

Chi Ying Simon Chow    -  Contact Me
Prince of Wales Hospital, Hong Kong SAR

Takuya Fujikawa    -  Contact Me
Prince of Wales Hospital, Hong Kong SAR

Randolph Wong    -  Contact Me
Prince of Wales Hospital, Hong Kong SAR

Jacky Yan Kit Ho    -  Contact Me
Prince of Wales Hospital, The Chinese University of Hong Kong

Objective: Endoleak arises as a specific set of complications from endovascular treatments in complex aortic pathologies, that warrants the longer-term surveillance and technical challenges in salvage scenarios. A case of symptomatic concealed rupture of descending aorta with previous endovascular stents demonstrated the importance of endoleak identification and open descending repair techniques.

Case Video Summary: A 67-year-old patient with previous complex thoracic aortic interventions involved staged endovascular treatments and total aortic arch replacement, found to have a symptomatic concealed descending aortic rupture. Preoperative imaging showed no active extravasation or definite endoleak, with only a suspicious of migration previous stent graft components. Open descending surgery was offered for severe back pain and persistent anaemia, confirmed a type III endoleak as the major culprit. Routine left thoracotomy approach of descending aortic surgery exposed the ruptured aortic wall. Upon stent graft components exposure and examination of endoleak, the culprit type III endoleak was treated with direct surgical repair and reinforcements. Furthermore, type II and IV endoleaks were also identified and treated, distal sealing of the stent graft to native aorta was reinforced. Patient recovered well and was discharged 12 days postoperatively with resolved back pain and no neurological complication.

Conclusions: Endovascular treatments expanded the treatment options for aortic pathologies, it arises a specific set of complications and treatment challenges. The current case showed the indispensable role of open repair in descending aortic treatments. The importance of surveillance after aortic interventions and timely endoleak management is demonstrated.

Descending/Thoracoabdominal Aorta