Endovascular Management of Nonaneurysmal Abdominal Aortic Rupture

Endovascular Management of Nonaneurysmal Abdominal Aortic Rupture

Antonios P. Gasparis, M.D.
Phil Wall, M.D.
John J. Ricotta, M.D.
SUNY Stony Brook, Stony Brook, NY

Brief Case History

A 67-year-old man with a history of severe cardiomyopathy and a functional renal transplant was found to have a contained retroperitoneal rupture of the perirenal aorta on CT scan (Fig 1) with a heavily calcified and normal caliber aorta just proximal and distal to the area of rupture. Multiple comorbidities prompted us to proceed with endovascular repair. From the left femoral artery an AneuRx graft was deployed below the superior mesenteric artery (Fig 2). Canulation of the contralateral gate was unsuccessful because it was constrained by the normal sized aorta. Conversion into uni-iliac system was achieved by placing aortic extension cuffs across the flow divider (Fig 3). A cross-femoral bypass to perfuse the right extremity and the transplanted kidney followed this (Fig 4). The right common iliac artery was ligated through a retroperitoneal approach.

Spontaneous rupture of a nonaneurysmal abdominal aorta is a rarely encountered pathology, which may result from atherosclerotic ulcer, dissection or infectious aortitis. The absence of an aneurysmal aorta may result in failure of proper deployment of currently available bifurcated devices. In addition, available aortic cuffs are not of adequate length and may result in slippage. Placement of recently available aorto uni-iliac devices is the preferred endoluminal approach to this problem.