PMC9351984_01
Computed tomography with intravenous contrast. (A) Axial slice; A: aorta; the asterisks mark an image compatible with periaortic collection/mass. (B) Reconstruction with the maximum intensity projection (MIP) technique. Observe the irregular outlines not just of the aneurysm, but also of the aortic segments proximal (black arrow) and distal (white arrows) of the aneurysm.
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Angiotomography showed a fusiform aneurysm of the infrarenal aorta, with a maximum diameter of 3.6 cm and lobed outlines, surrounded by hypodense hematoma, with no signs of active bleeding, but with interrupted parietal calcifications and penetrating ulcerations, in addition to an inaccurate definition of the posterior aortic outline, suggestive of an infrarenal abdominal aortic aneurysm with signs of contained rupture (Figure 1).
Intraoperative images. (A) Temporary hemostasis with endoluminal inflation of Foley catheters in the iliac arteries; (B) Vascularized pedicle of the great omentum; (C) Pedicle of the great omentum in position to be wrapped around the tubular Dacron graft.
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Distal control was obtained by intraluminal inflation of Foley catheters in the common iliac arteries (Figure 2A). An aorto-aortic Dacron graft was used for reconstruction, wrapped in a vascularized pedicle of the greater omentum (Figures 2B, 2C, and 3).
Diagrams illustrating the tubular Dacron graft. (A) Omentum, right gastroepiploic artery (thin arrow) and left gastroepiploic artery (thick arrow); (B) Abdominal aorta after implantation of the Dacron graft. C) Omentum wrapped around the abdominal aortic graft.
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An aorto-aortic Dacron graft was used for reconstruction, wrapped in a vascularized pedicle of the greater omentum (Figures 2B, 2C, and 3).
PMC9351984_02
Intraoperative images. (A) Large aneurysm of the infrarenal aorta. (B) Tubular Dacron graft. The arrow indicates where the posterior wall of the aorta was resected. The proximal anastomosis is already concluded.
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Dacron aorto-aortic graft (Figure 4). During the postoperative period, the patient developed renal dysfunction and nosocomial pneumonia; an aorta wall culture revealed Escherichia coli, and the antibiotic therapy was changed to piperacillin with tazobactam and vancomycin.
PMC9351984_03
Computed tomography with intravenous contrast, axial slice. (A) Aorta; the asterisks mark an image compatible with periaortic collection/mass.
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Angiotomography confirmed a 5.7 cm juxtarenal saccular aneurysm and periaortic collection (Figure 5).
Intraoperative images. Aortoiliac graft with bifurcated silver-impregnated Dacron prosthesis.
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Reconstruction was performed with an 18x9 mm bifurcated Dacron aortoiliac graft wrapped in a vascularized pedicle of the greater omentum (Figure 6).