Background and Aims: The development and promotion of endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) have significant prolonged the survival of patients, but also accompanied by an increasing incidence of long-term complications, and among them, the most serious one is postoperative dilation and eventual rupture of the aortic/iliac artery, which is highly severe and difficult to treat. This study was conducted to investigate and summarize the treatment strategies for this condition through retrospective analysis of cases with late rupture of the abdominal aortic/iliac artery aneurysm after previous EVAR treated in our center.
Methods: The clinical data of 21 patients with late rupture of the abdominal aortic/iliac artery aneurysm after EVAR for AAA undergoing surgical treatment from June 2016 to August 2020 were retrospectively analyzed. Of the patients, 18 cases (85.7%) were males; the maximal diameter of aortic and iliac artery were (111.1±13.1) mm and (100.4±6.6) mm; the duration from EVAR to aortic rupture was (62.0±21.2) months; the reasons including type I endoleak in 15 cases (71.4%), type II endoleak in 4 cases (19.0%) and unclear endoleak in 2 cases (9.5%).
Results: Five patients (23.8%) received emergency operation, 10 patients (47.6%) underwent endovascular procedure and 11 patents (52.4%) were subjected to open surgery of balloon occlusion of the balloon plus coarctation suture of the aortic/iliac artery. The average operative time for endovascular and open surgery were (68.1±12.0) min and (236.4±48.6) min. Perioperative death occurred in one patient (4.8%). The length of intensive care unit stay after open surgery was 1–3 d. The mean follow-up period was (21.3±17.7) months, and 2 patients (2/9, 22.2%) undergoing endovascular treatment received secondary operation for abdominal aortic complications.
Conclusion: Late rupture of abdominal aortic/iliac artery aneurysm is a severe long-term complication after EVAR. Endoleak, especially the type I endoleak, is the main cause for this condition. Endovascular aortic repair is the first treatment option. The open surgery of balloon occlusion of the balloon plus coarctation suture of the aortic/iliac artery is relatively safe and effective.