PMC5554120_01
A large pulsatile abdominal mass observed during clinical examination.
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F1
Physical examination revealed a large pulsatile abdominal mass (Figure 1), low blood pressure (90/50 mmHg), and an increased heart rate (95/min).
Computed tomography angiography images showing a rupture of the aneurysm sac that causes a large retroperitoneal hematoma (thin arrows). Blood pools are observed within the hematoma (thick arrows) although no typical endoleak can be identified.
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F2
The CTA images did not show any obvious type of endoleak (Figure 2).
The patient received a laparotomy (left figure) and a large retroperitoneal hematoma was identified (right figure).
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F3
The patient underwent an emergency laparotomy where the retroperitoneal hematoma was identified (Figure 3).
A large amount of thrombus/hematoma removed from within the aneurysm sac.
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F4
The aneurysm sac was incised, a large amount of thrombus/hematoma was removed (Figure 4), and leakage was identified through the fabric of the left graft limb (Figure 5), although no patent lumbar artery was found after removal of the thrombus.
A microleakage identified to originate from the middle part (non-overlapping) of the left graft limb (arrow).
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F5
The aneurysm sac was incised, a large amount of thrombus/hematoma was removed (Figure 4), and leakage was identified through the fabric of the left graft limb (Figure 5), although no patent lumbar artery was found after removal of the thrombus.
A synthetic silver-coated Dacron patch (arrow) was wrapped around the left graft limb in order to seal the microleakage. The aneurysm sac was sutured to cover the endograft.
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F6
It was decided by the authors to cover the left limb of the graft with a silver-coated Dacron patch in order to seal the leakage, and the aneurysm sac was sutured over the graft (Figure 6).
Postoperative computed tomography angiography images showing the graft wrapped by the sac without any sac enlargement or obvious endoleak.
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F7
Postoperative CTA images did not show any enlargement of the sac or any new type of endoleak (Figure 7).