PMC6629609_01
CT angiogram images of the abdominal aorta in the juxtarenal area (A) showing right side, posterolateral blurring compatible with peri-aortic haematoma, probably from rupture of the aorta (red arrows) (B).
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Other tomographic findings were areas of calcification of the aorta suggestive of atherosclerotic disease with no aneurysm or dissection (Fig. 1).
Angiographic images of endovascular treatment to place a bifurcated endoprosthesis with juxtarenal proximal anchoring (A and B).
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Urgent endovascular aortic repair with a bifurcated endoprosthesis was performed (main body: 36x16x145 mm, extensions: 16x13x124 mm and 16x16x80 mm), with juxtarenal proximal anchoring and distal anchoring in the common iliac arteries (Fig. 2).
CT angiogram of the thorax, showing spontaneous rupture of a descending thoracic segment of the aorta, with peri-aortic haematoma (red arrows) (A) with a diameter of 7.3 cm (B).
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CT angiography revealed a second spontaneous rupture, this time of a descending thoracic segment, with a 7.3 cm diameter peri-aortic haematoma (Fig. 3).
Angiographic images of the procedure, showing spontaneous rupture of a descending thoracic segment of the aorta (A) and endovascular treatment with placement of a straight thoracic endoprosthesis (B), sealing the injury.
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A second endovascular procedure was performed, this time to implant a straight thoracic endoprosthesis (34x34x150 mm) which sealed the tear and improved symptoms (Fig. 4).
CT angiogram of the thoracic and abdominal aorta showing another spontaneous rupture in a segment of the aorta close to the coeliac trunk (red arrows) (A and B).
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CT angiography of the thoracic and abdominal aorta showed another spontaneous rupture, in a segment of the aorta close to the coeliac trunk (Fig. 5).
Angiographic images of the procedure, showing the spontaneous rupture in a segment of aorta close to the coeliac trunk (A), and endovascular treatment with a straight thoracic endoprosthesis, anchoring with a catheter positioned in the coeliac trunk to protect it (red arrow) (B), and showing a good result, sealing the latest injury.
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He was treated endovascularly for a third time, implanting a 34x34x150 mm straight thoracic endoprosthesis, anchored via a catheter positioned within the coeliac trunk to protect it, with good results (Fig. 6).
CT angiogram of the thoracic and abdominal aorta, showing leakage from a distal segment of the straight thoracic endoprosthesis implanted as part of the third procedure (red arrow) (A) and patency of all of the visceral trunks (B and C).
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Because the leak was minor and the haematoma smaller (Fig. 7), no further intervention was planned.
CT angiogram of the thoracic and abdominal aorta, showing correctly positioned endoprostheses and an absence of leaks (A, B, and C).
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A follow up CT angiogram six months later showed complete resolution of the endoleak (Fig. 8).