The Utilization of the Double-Bubble Aortic Configuration to Seal Infra-Renal Aortic Aneurysms: A Case Report and Review of Literature

Abstract

An 80-year-old Caucasian female with a symptomatic pararenal aortic aneurysm (AAA) presented with severe abdominal pain radiating to the back, which was associated with a significantly tender pulsating abdominal mass. The patient was deemed unfit for open repair, secondary to her significant multiple comorbidities. Her preoperative computed tomography (CT) angiography showed a 6 cm pararenal AAA with a short hostile neck; however, her aneurysm had a double-bubble sign, which we utilized as an adjunct for sealing zones. A 36-mm Cook Zenith device was deployed with complete exclusion of the AAA. The patient recovered uneventfully with complete resolution of her abdominal pain. On her 2-month follow-up CT angiography, there was no migration or endoleak, with a decrease in the aneurysm sac size. This case report highlights the benefit of having such an aortic configuration as an adjunct tool for proximal sealing zones and demonstrates that certain anatomy may be beneficial in selected patients.

Keywords

double bubble aortic aneurysm aortic neck

References

Hobo R. , Kievit J. , Leurs LJ , Buth J. Influence of severe infrarenal aortic neck angulation on complications at the proximal neck following endovascular AAA repair: a EUROSTAR Study. J Endovasc Ther. 2007;14(1):1-11.

Fulton JJ , Farber MA , Sanchez LA , et al. Effect of challenging neck anatomy on mid-term migration rates in AneuRx endografts. J Vasc Surg. 2006;44(5):932-937.

Sternbergh WC 3rd , Carter G. , York JW , Yoselevitz M. , Money SR Aortic neck angulation predicts adverse outcome with endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2002;35(3): 482-486.

Parodi JC , Palmaz JC , Barone HD Transfemoral graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5(6): 491-499.

Harris PL , Vallabhaneni SR , Desgranges P. , Becquemin JP , van Marrewijk C. , Laheij RJ Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European Collaborators on Stent/graft techniques for aortic aneurysm repair. J Vasc Surg. 2000;32(4):739-749.

Li , Z. Kleinstreuer , C. Effects of major endoleaks on a stented abdominal aortic aneurysm. J Biomech Eng. 2006;128(1):59-68.

Sampaio SM , Panneton JM , Mozes GI , et al. Proximal type I endoleak after endovascular abdominal aortic aneurysm repair: predictive factors. Ann Vasc Surg. 2004;18(6):621-628.

Albertini J. , Kalliasfas S. , Travis S. , et al. Anatomical risk factors for proximal perigraft endoleak and graft migration following endovascular repair of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2000;19(3):308-312.

AbuRahma AF , Campbell J. , Stone PA , et al. The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients. J Vasc Surg. 2009;50(4):738-748.

10.

Leurs LJ , Kievit J. , Dagnelie PC , Nelemans PJ , Buth J. Influence of infrarenal neck length on outcome of endovascular abdominal aortic aneurysm repair. J Endovasc Ther. 2006;13(5):640-648.

11.

Greenberg RK , Sternbergh WC , Makaroun M. , et al. Intermediate results of a United States multicenter trial of fenestrated endograft repair for juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2009;50(4):730-737.