Infected Aortic Endograft

The patient previously underwent aortic aneurysm repair using endograft. Several years after the procedure the patient developed abdominal pain and fever.

The upper image above demonstrates the appropriate position of the endograft.

CT of the abdomen revealed the presence of air (white arrow on the bottom image) within the endograft indicating possible graft infection. Tagged WBC scan was also suggestive of infection.

The patient underwent endograft removal. The presence of the aorto-duodenal fistula was also discovered during surgery (not clearly evident on the above images).

Surprisingly, the patient did not have any evidence of gastrointestinal bleeding.

Bilobed Abdominal Aortic Aneurysm

The image above demonstrates a AAA with an interesting shape. The aneurysm originates just below the renal arteries and takes a bilobed shape with a narrowed section of the aorta in between.

The new technology allows us to create a 3-D reconstruction of the complex anatomical structure making it easier for the surgeon to operate on the patient.

This is a 3-D reconstruction image of a large abdominal aortic aneurysm (see arrows on the image above). Hypertension and atherosclerosis are the biggest risk factors. Smoking contributes as well. The aneurysm had grown to more than 5 cm in diameter and required surgical intervention. Note renal arteries above and iliac arteries below the aneurysm.

Abdominal Aortic Aneurism

Risk factors and epidemiology
Abdominal aortic aneurism (AAA) is a focal dilation of the abdominal aorta. Most commonly it occurs between the renal and inferior mesenteric arteries. The incidence of AAA increases dramatically with age. Other risk factors for AAA include: smoking, being a male, history of atherosclerosis, hypertension and a family history of AAA. Inflammation plays an important role in AAA development.

Symptoms
Most patients with AAA are asymptomatic. Symptoms, if present, usually include abdominal and back pain. Symptomatic aneurisms are at a higher risk of rupture.

Ruptured AAA is a surgical emergency. Aneurism rupture can cause rapid exsanguination and shock.

Diagnosis
The diagnosis of AAA is usually made by CT scan of the abdomen. Aneurism can also be detected by MRI and the Ultrasound.

Treatment
The treatment and monitoring of AAA typically depends on the size of the aneurism:

Aneurysms 4.0 to 5.4 cm in diameter should be monitored by ultrasound or CT every 6 to 12 months.

Aneurysms 3.0 to 4.0 cm in diameter should be monitored by ultrasound every two to three years.

Medical therapy consists of blood pressure control and risk factors modification.

Surgery is indicated if the size of the aneurism is twice the size of the adjacent aorta. Symptomatic patients are offered surgery regardless of the size. Rapid aneurism expansion (>0.5cm in 6 mo) and the location of the aneurism are also considered when making decision on surgical treatment.

86 year old male presented with severe abdominal pain. CT abdomen revealed ruptured AAA. The patient was urgently taken to OR for AAA repair.