Infrarenal Rupture of an Abdominal Aortic Aneurysm, Previously Repaired Using an Endoaneurysmorrhaphy Technique

Unusual as well as well-known complications can occur after aortic reconstruction. In an effort to heighten awareness of these possibilities, a case is presented of a 71-year-old male who was brought to the emergency department with severe back pain of 2 days duration and hypotension. He had undergone repair of an infrarenal abdominal aortic aneurysm 6 years earlier. An emergency computed tomography scan demonstrated a 10-cm abdominal aortic aneurysm extending from just above the celiac axis, through the aortic bifurcation, with retroperitoneal and intraperitoneal hematoma. He was found at operation to have extension of his aneurysmal disease proximally, with complete separation of the proximal suture line, and rupture of the distal aortic wall. Since the aneurysm had been closed around the graft at the time of the original operation, his aneurysm had essentially been restored, and the diseased wall was again exposed to the tensile stresses from the pulsatile column of blood. Emergency repair was successful, despite postoperative complications including myocardial infarction, and later rupture of an iliac artery aneurysm. Patients presenting with signs and symptoms consis-tent with a ruptured abdominal aortic aneurysm after previous repair should be addressed aggressively with computed tomography if it is immediately available and the diagnosis is in doubt. The patient should then undergo an immediate operation. Such recurrence, although rare, must always be considered a possibility. Similar scenarios may be encountered secondary to endoleaks occurring after endoluminal aortic repairs