Aneurysm Rupture After Stent Grafting
Value of Dynamic Imaging
A 67-year-old man presented at the emergency department with abdominal pain. Six years earlier, he was treated with an endograft for an infrarenal aortic aneurysm. Five years postoperatively, he developed a proximal endoleak caused by graft migration that was treated with implantation of a second endograft. On presentation, ECG-gated computed tomographic angiography showed contrast outside the endograft with a rupture of the aneurysm sac. The patient was taken to surgery for emergency open repair, which he did not survive. Dynamic imaging, reconstructed after surgery, revealed a systolic blush of contrast out of the endograft caused by a fabric tear (Figure, A, Movies I and II of the online Data Supplement). This was confirmed at explantation (Figure, B). The stent graft fabric seemed to be eroded by the continuous movements of the aortic endografts. If the cine computed tomographic angiography images would have been available before surgery, a minimally invasive endovascular procedure could have been performed easily with potentially a more favorable outcome.
Drs van Herwaarden, Moll, and Verhagen have received an unrestricted research grant from 3Mensio Medical Imaging BV, Bilthoven, the Netherlands. The other authors report no conflicts.
The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/119/10/e232/DC1.