Avgerinos Konstantinos Ioannis, Melas Nikolaos, Saratzis Athanasios, Tympanidou Marianthi V, Saratzis Nikolaos, Lazaridis Ioannis
Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
Case Rep Vasc Med. 2018 Apr 24;2018:1502328. doi: 10.1155/2018/1502328. eCollection 2018.
We report a case of a ruptured abdominal aortic aneurysm (AAA) caused by a combined type IIIb and Ia endoleak. Also, we propose the mechanism that resulted in this combined endoleak. Specifically, a 71-year old-man, with a previous history of endovascular aneurysm repair (EVAR) for an AAA, was diagnosed with a contained rupture. CT scan depicted a type Ia endoleak and a migrated Talent endograft. A proximal aortic cuff sealed the endoleak, but intraoperative angiography revealed that a type IIIb endoleak coexisted due to fabric tear close to the Talent bifurcation. A second aortic cuff could not seal the fabric tear; so, in-lay parallel limbs were sequentially deployed as a "kissing endograft" technique inside the cuff. Simultaneous treatment of combined type IIIb and Ia endoleaks has not yet been described. Maybe the type IIIb endoleak is the primary entity causing sac enlargement, neck recontouring, proximal migration, and ultimately type Ia endoleak, which leads to huge enlargement and rupture. Placement of an aortic cuff to seal the proximal endoleak/migration and kissing endografts limbs for the fabric tear seems a safe option in such patients.
我们报告一例由IIIb型和Ia型内漏合并引起的腹主动脉瘤（AAA）破裂病例。此外，我们提出了导致这种合并内漏的机制。具体来说，一名71岁男性，既往有腹主动脉瘤血管内修复术（EVAR）病史，被诊断为局限性破裂。CT扫描显示Ia型内漏和移行的Talent血管内支架移植物。近端主动脉套囊封闭了内漏，但术中血管造影显示由于靠近Talent分叉处的织物撕裂，IIIb型内漏并存。第二个主动脉套囊无法封闭织物撕裂处；因此，作为“吻合血管内支架移植物”技术，在套囊内依次部署了镶嵌平行分支。IIIb型和Ia型内漏合并的同步治疗尚未见报道。也许IIIb型内漏是导致瘤腔扩大、颈部重塑、近端移行并最终导致Ia型内漏的主要因素，而Ia型内漏会导致瘤腔巨大扩大和破裂。对于此类患者，放置主动脉套囊以封闭近端内漏/移行，并使用吻合血管内支架移植物分支来处理织物撕裂似乎是一种安全的选择。
