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Title: Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient

Abstract

A renal transplant recipient presented in the early post-transplantation period with rupture of an abdominal aortic aneurysm. The high mortality rate of the surgical repair of ruptured aneurysm in addition to the concern of preserving the renal graft prompted us to seek alternative approaches, such as repairing the aneurysm by means of endovascular techniques. The ruptured aneurysm was confirmed by performing computed tomography and digital angiography and thereafter was successfully repaired by endovascular stenting technique (Talent stent-graft), which seems to be a safe and effective method of preserving a renal graft.

Authors:
 [1];  [2]; ;  [3];  [2]; ;  [4]; ;  [2]
  1. 'Evangelismos' General Hospital, Unit of Interventional Radiology, Department of Radiology (Greece), E-mail: kaskarelis1@yahoo.com
  2. 'Evangelismos' General Hospital, Transplant Unit, First Department of Surgery (Greece)
  3. 'Evangelismos' General Hospital, Unit of Interventional Radiology, Department of Radiology (Greece)
  4. 'Evangelismos' General Hospital, Department of Vascular Surgery (Greece)
Publication Date:
OSTI Identifier:
21091259
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 29; Journal Issue: 2; Other Information: DOI: 10.1007/s00270-004-9205-6; Copyright (c) 2006 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; BLOOD VESSELS; COMPUTERIZED TOMOGRAPHY; GRAFTS; KIDNEYS; MORTALITY; REPAIR; RUPTURES; SURGERY

Citation Formats

Kaskarelis, Ioannis S., Koukoulaki, Maria, Lappas, Ioannis, Karkatzia, Fani, Dimopoulos, Nikitas, Filias, Vasilios, Bellenis, Ion, Vougas, Vasilios, and Drakopoulos, Spiros. Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient. United States: N. p., 2006. Web. doi:10.1007/S00270-004-9205-6.
Kaskarelis, Ioannis S., Koukoulaki, Maria, Lappas, Ioannis, Karkatzia, Fani, Dimopoulos, Nikitas, Filias, Vasilios, Bellenis, Ion, Vougas, Vasilios, & Drakopoulos, Spiros. Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient. United States. doi:10.1007/S00270-004-9205-6.
Kaskarelis, Ioannis S., Koukoulaki, Maria, Lappas, Ioannis, Karkatzia, Fani, Dimopoulos, Nikitas, Filias, Vasilios, Bellenis, Ion, Vougas, Vasilios, and Drakopoulos, Spiros. Sat . "Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient". United States. doi:10.1007/S00270-004-9205-6.
@article{osti_21091259,
title = {Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient},
author = {Kaskarelis, Ioannis S. and Koukoulaki, Maria and Lappas, Ioannis and Karkatzia, Fani and Dimopoulos, Nikitas and Filias, Vasilios and Bellenis, Ion and Vougas, Vasilios and Drakopoulos, Spiros},
abstractNote = {A renal transplant recipient presented in the early post-transplantation period with rupture of an abdominal aortic aneurysm. The high mortality rate of the surgical repair of ruptured aneurysm in addition to the concern of preserving the renal graft prompted us to seek alternative approaches, such as repairing the aneurysm by means of endovascular techniques. The ruptured aneurysm was confirmed by performing computed tomography and digital angiography and thereafter was successfully repaired by endovascular stenting technique (Talent stent-graft), which seems to be a safe and effective method of preserving a renal graft.},
doi = {10.1007/S00270-004-9205-6},
journal = {Cardiovascular and Interventional Radiology},
number = 2,
volume = 29,
place = {United States},
year = {Sat Apr 15 00:00:00 EDT 2006},
month = {Sat Apr 15 00:00:00 EDT 2006}
}
  • Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta.
  • The purpose of this study was to determine whether surgeons without formal radiological training are able to assess suitability of patients with ruptured abdominal aortic aneurysms (AAA) for EVAR. The CT scans of 20 patients with AAA were reviewed under timed conditions by six vascular surgeons. Twenty minutes was allocated per scan. They were asked to determine if each aneurysm would be treatable by EVAR in the emergency setting and, if so, to measure for device selection. The results were then compared with those of a vascular radiologist. Six surgeons agreed on the suitability of endovascular repair in 45% ofmore » cases (95% CI, 23.1-68.5%; 9/20 scans; {kappa} = 0.41 [p = 0.01]) and concurred with the radiologist in eight of these. Individually, agreement ranged from 13 to 16 of the 20 scans, 65-80% between surgeons. The kappa value for agreement between all the surgeons and the radiologist was 0.47 (p = 0.01, moderate agreement). For the individual surgeons, this ranged from 0.3 to 0.6 (p = 0.01). In conclusion, while overall agreement was moderate between the surgeons and the radiologist, it is clear that if surgeons are to assess patients for ruptured EVAR in the future, focused training of surgical trainees is required.« less
  • PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasationmore » of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.« less
  • Abdominal aortic aneurysm (AAA) repair in the presence of a kidney transplant can be extremely challenging, as it carries significant risks of renal ischemia. Endovascular repair is an attractive option, as it can be performed with little or no impairment of renal arterial flow. We describe the endovascular management of a recurrent AAA in a patient with a functioning renal transplant using a custom-made aorto-uni-iliac device. We discuss the planning and the potential problems of the technique.
  • Aneurysm sac expansion following endovascular abdominal aortic aneurysm repair (EVAR) is typically associated with endoleaks that can be readily diagnosed on computed tomographic angiography (CTA), ultrasound, or catheter-directed arteriography. Sac hygromas are a cause of sac expansion without apparent endoleak and are presumed to be a result of ultrafiltration of serum manifested by accumulation of fibrinous, gelatinous material within the aneurysm sac following EVAR. Although there are no reported associated ruptures, sac expansion is nevertheless disconcerting and intervention is presumably indicated. We report a case of an expanding aneurysm after EVAR secondary to sac hygroma that was successfully treated withmore » relining of the existing, original endograft.« less