PMC6019691_01
(A) A computed tomography (CT) scan showing an infrarenal saccular abdominal aortic aneurysm (AAA) 5 cm in diameter, 5 cm below the right renal artery and 3 cm above the aortic bifurcation. The diameter of the aorta above and below the aneurysm is 16 and 15 mm respectively. (B) Six month post-procedure follow up CT scan demonstrating no endoleak, migration, or kinking of the stent graft. (C) CT scan demonstrating migration and kinking of the stent graft, which takes up space in the sac causing migration of the distal landing zone. The proximal landing zone and distal landing zone become aneurysmal, caused by an oversized stent graft and fragile aortic tissue. (D) A CT scan with oral contrast showing close contact and loss of the fat streak between the bowel and the aneurysm with air in the aneurysm sac.
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Follow up CT scans performed three and six months after the procedure demonstrated a decrease in the size of the aneurysm sac without endoleak, migration, or kinking of the stent graft (Fig. 1B). A CT scan showed migration and kinking of the stent without endoleak (Fig. 1C). A CT scan with oral contrast showed close contact and loss of the fat streak between the bowel, and air in aneurysm sac (Fig. 1D). A diagnosis of stent graft infection secondary to AEF was confirmed by CT scan (Fig. 1D).
Histopathological analysis of abdominal aortic aneurysm specimens showing fibrotic inflammatory cellular infiltrate with blood clots in the media. (A) Granulation tissue with many haemosiderin laden macrophages (H&E, x40). (B) Many neutrophils and histiocytes within the thrombus (H&E, x400).
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There was evidence of an old haemorrhage within the granulation tissue (Fig. 2A). The thrombus associated with the fistula wall contained several foci of neutrophil and histiocyte aggregation (Fig. 2B).