Surgical Versus Endovascular Aortic Aneurysm Repair: Evidence to Guide the Optimal Approach for the Individual Patient

Endovascular abdominal aortic aneurysm repair in a patient with previous history of simultaneous orthotopic liver kidney transplantation

Management of abdominal aortic aneurysms (AAA) tends to be an issue in patients with a previous history of abdominal transplantation surgeries. Open surgery poses the risk of ischemia to the grafted tissue. Additionally, these patients have comorbidities that make them unable to endure such procedures. As a result, endovascular repair is becoming the accepted procedure in the transplanted population. Herein, we describe a patient with a previous history of simultaneous orthotopic liver-kidney transplantation who successfully underwent EVAR for AAA correction.

Use of Gore C-TAG with active control to treat a complex infrarenal abdominal aortic aneurysm

Complex abdominal aortic aneurysms (AAAs) can preclude the use of endovascular aortic repair. In patients unable to undergo open surgical repair (OSR), the use of endografts outside the instructions for use might be the only option. We present the case of a woman with a highly angulated infrarenal AAA neck who was unsuitable for OSR and was successfully treated using a Gore C-TAG conformable thoracic stent graft (W.L. Gore and Associates, Inc, Flagstaff, Ariz) with active control, Medtronic Heli-FX EndoAnchors (Medtronic Vascular, Minneapolis, Minn), and a bifurcated Gore Excluder endoprosthesis W.L. Gore and Associates). The repair was successful without evidence of an endoleak. Using a thoracic endograft outside of the instructions for use to treat infrarenal AAAs might be feasible for patients unable to undergo OSR.

Aortoenteric fistula secondary to an Inflammatory Abdominal Aortic Aneurysm

Primary aortoenteric fistulas are rare, with the annual incidence of such fistulas estimated to be 0.007 per million. The most common predisposing conditions for primary aortoenteric fistulas are atherosclerotic abdominal aortic aneurysms or penetrating atherosclerotic ulcers. We illustrate a rare case of an inflammatory aortic aneurysm causing a primary aortic fistula, with a direct fistulous jet from the aorta to the bowel with resultant catastrophic bleeding. In contrast to atherosclerotic aneurysms, most inflammatory aneurysms are symptomatic and show dense perianeurysmal fibrosis and periaortic wall thickening. A direct jet of contrast extravasation from the aorta into a bowel loop, while rarely seen, remains the most specific sign of a primary aorta-enteric fistula. A comprehensive literature review of the clinical presentation, imaging features, and differential diagnosis of a primary aortoenteric fistula are also discussed.