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Sagittal CT images indicating enlarged aneurysm sac (left) and para-aortic fat stranding (right) representing periaortitis.
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We present a case of a 73-year-old gentleman with an aortic endograft infection post endovascular abdominal aneurysm repair (EVAR), from whence erosion has come in from an acutely inflamed appendix. To our best understanding, there is no similar case published in the literature. Intra-operatively, there was obvious inflammation and oedema over the...
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Citations
... Explantation of infrarenal aortic endografts has been previously described. [1][2][3][4][5][6][7][8][9][10] To the best of our knowledge, currently, no cases have been reported on the operative technique to explant aortic endografts designed with polymer rings to facilitate a proximal seal (ALTO Abdominal Stent Graft; Endologix). Explanation, because of the polymer ring, poses unique challenges compared with other devices with suprarenal fixation. ...
Explantation of traditional infrarenal aortic endografts has been previously described, and explanation of aortic endografts with standard suprarenal fixation at our center has been well defined. However, to the best of our knowledge, no cases have been reported on explantation of endografts with polymer rings present to facilitate the proximal seal. By obtaining full thoracoabdominal exposure with supraceliac clamping and opening the entire aorta along the graft, we were able to successfully explant the ALTO stent graft with polymer rings. (J Vasc Surg 2024;XX:XX-X.)
... The favorable incision-evacuation of the abscess and the successful medical treatment of diverticular disease were decisive in this case. Infection of an EVAR prosthesis (AAA treatment) by AAp 1 [34] Ruptured AAA induced by AAp 1 [30] Primary aorto (AAA)-appendicular fistula 1 [35] Secondary aorto (prothesis post-AAA surgery)-appendicular fistula 13 [36] [37]*** [38] Peña et al. J Med Case Reports (2021) 15:203 The relationship between AAA and appendicitis is rare and therefore scarcely described in the medical literature (Table 1). ...
... J Med Case Reports (2021) 15:203 The relationship between AAA and appendicitis is rare and therefore scarcely described in the medical literature (Table 1). Its association modifies the clinical presentation (ruptured AAA that simulates appendicitis or the opposite as in our case) [26,27] or induces serious complications, such as aneurysm [28][29][30] or endoprosthesis [31][32][33][34]. Finally, cases of primary [35] and secondary [36][37][38] aorto-appendicular fistulas have been described. ...
Background
Abdominal aortic aneurysm and acute appendicitis occur relatively frequently in elderly patients. However, the co-occurrence of the two pathologies is very rare and serious.
Case presentation
We present the case of an elderly Caucasian patient who was aware of having an abdominal aortic aneurysm but refused treatment and was subsequently admitted to the hospital’s emergency department with acute abdominal symptoms. A computed tomography scan raised the possibility of complication due to the characteristics of the aneurysm. The patient then agreed to emergency surgery. Laparotomy revealed the existence of an acute perforated appendicitis with a significant abscess in the right iliac fossa and an uncomplicated aneurysm. Appendectomy was performed and the abscess drained. The postoperative period passed without complications, and the patient again refused surgery for the aneurysm, which due to its anatomical characteristics was not a candidate for standard endovascular treatment.
Conclusions
In light of this experience, we review the literature about the relationship between abdominal aortic aneurysm and acute appendicitis.
Introduction: Endovascular aortic repair (EVAR) has improved over the last two decades. Approximately 80% of the patients presenting with an abdominal aortic aneurysm (AAA) is nowadays primarily treated with EVAR.
Areas covered: In this review the differences between endovascular and open repair, the clinical characteristics needed for EVAR, the role of clinical imaging and the developments in EVAR technology will be discussed. Early mortality is lower in EVAR as compared to open repair, whereas this benefit is lost after three years postoperatively. EVAR comes with a high reintervention rate, with endoleak being the most important predictive factor for reintervention. Expanding technical possibilities have allowed surgeons to choose from a palate of endovascular approaches in aneurysm patients with challenging anatomies.
Expert commentary: Although EVAR has taken a giant leap forward in development, the new developments have seemed to surpass the long term limitations with older devices. It is important to start focusing on the current limitations of EVAR, in particular the durability of devices in the human variable anatomic and dynamic environment.
