Aortic Banding to Treat Simultaneously a Type Ia Endoleak and Aortic Neck Rupture during Endovascular Abdominal Aortic Aneurysm Repair

Background: Type Ia endoleak due to inadequate seal at the proximal end of the endograft is not infrequent during the initial operation. However, repeated attempts at balloon inflation or over-dilatation of the balloon can produce high axial pressures and can lead to aortic neck rupture with hemodynamic instability. Methods: The purpose of the paper is to present a useful technique for simultaneously treating a type Ia endoleak and aortic neck rupture during endovascular abdominal aortic aneurysm repair. Results: The technique for treating a type Ia endoleak has been described, but it was used for the first time to treat simultaneously a type Ia endoleak and rupture of the aortic neck with active bleeding during endovascular abdominal aortic aneurysm repair. After laparotomy, the left renal vein was ligated and a proximal control was achieved with placement of a vascular clamp above the renal arteries. Effective external banding of the infrarenal neck was performed with two 10-mm polyester Dacron limbs tied in the same fashion, close to one another, and parallel just below the renal arteries. We describe the steps of the surgical technique in detail and we analyze crucial issues associated with the technique. Conclusions: In this paper, we presented a useful technique for simultaneously treating a type Ia endoleak and aortic neck rupture during endovascular abdominal aortic aneurysm repair. Effective external banding of the infrarenal neck led to control of the hemorrhage and exclusion of the blood flow in the aneurysm sac.