Author + information
- Jang Yong Kim1
Patient initials or identifier number
Relevant clinical history and physical exam
The 75-year-old man presented with growing aneurysm after open surgical repair of AAA with PTFE bifurcated graft six years ago. He complained of abdominal discomfort and a palpable mass in the absence of tenderness, pulse, and bruit.
Relevant test results prior to catheterization
The patient has a history of PCI for coronary heart disease and 10-years of HTN. Blood chemical examinations were normal without Creatinine (1.5 mg/dl). Contrast-enhanced computed tomography (CT) showed huge peri-graft seroma measuring approximately 111-cm in diameter and starting from infrarenal aorta to middle of both iliac arteries. PET-CT proved that no evidence of infection was found in seroma.
Relevant catheterization findings
Abdominal aortography showed no graft leak and communication between the sac and the arterial blood flow. Relining of PTFE graft with Excluder cuff (23 mm) and Viabahn (10 mm x 10 cm) done. We did not perform simple puncture and aspiration on an aneurysm sac. In 2 years follow-up, symptom disappeared and CT scan showed Decreased sac size down to 45 mm x 60 mm.
Endovascular relining of PTFE graft. We used 23 mm Aortic extender, Excluder (W.L. Gore & Associates Inc. Flagstaff, Arizona, USA) and 10 mm x 10 cm sized stent-grafts, Viabahn. Excluder was deployed in the trunk of PTFE graft. After the relining of two Excluders, 10 mm-10 cm sized Viabahn was successfully implanted within the both iliac limb with chimney technique. The ancillary attachment between the original and the new stent-grafts made with a compliant balloon with 6 mm x 12 cm, successfully (Fig 2). We did not perform simple puncture and aspiration. A final aortogram was performed and there was no endoleak or flow disturbance.
In 2 years follow-up, patient symptom disappeared and CT scan showed decreased aneurysm sac size (45 x 60 mm). Endovascular relining should be considered to perigraft seroma after AAA open repair with PTFE graft.