Management of a dislocated endovascular aneurysm repair in a challenging giant abdominal aortic aneurysm

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Introduction A case report of a contained rupture of an abdominal aneurysm, treated by endovascular technique (EVAR), but complicated by perioperative endoprosthesis limb dislocation. Case report An 81-year old male presented at the emergency department with a contained rupture of an infrarenal aortic aneurysm and bilateral extensive iliac aneurysmatic disease. Open repair was no option, due to the pulmonary condition. The patient was prepped for an emergency EVAR. After placing a bifurcated endoprosthesis, angiography revealed a type IIIa endoleak, due to a dislocation between two left iliac extensions. We converted to a right-sided aorto-uni-iliac endoprosthesis with a femorofemoral bypass. A postoperative CT-scan showed a complete exclusion of the aneurysm, a patent aorto-uni-iliac endoprosthesis and a femorofemoral bypass without an endoleak. Discussion EVAR is feasible with a hostile neck AAA, even in a ruptured AAA. In large AAA, one should consider an overlap larger than suggested in the instructions for use.

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