Endovascular Treatment of a Late Complication of an Open Repair of Abdominal Aortic Aneurysm

Abdominal aortic aneurysms (AAA) are the most common type of aortic aneurysms. Traditionally it has been treated by open surgical repair (OSR), but in the last years endovascular repair (EVAR) became the first choice treatment in patients with suitable anatomy. Although the mortality and morbidity are lower with EVAR, late complications, such as endoleaks, remain a problem. Late complications after OSR are less frequent than after EVAR, but they still occur. We report a case of a patient with an uncommon late complication after OSR: limb occlusion of the Dacron prosthesis of an aortobifemoral bypass 14 years after. The rescue was performed by an unusual, but successful, urgent endovascular approach using intra-arterial thrombolysis with recombinant tissue plasminogen activator(r-tPA) followed by covered stents implantation in the Dacron limb prosthesis and balloon angioplasty in the origin of a previous saphenous vein femoropopliteal bypass grafting. Late complications after EVAR and OSR, as well as treatment options, are discussed here.