Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Vascular Rupture Caused by a Molding Balloon during Endovascular Aneurysm Repair: Case Report

증례: 복부 대동맥류의 혈관 내 치료 도중 Molding Balloon에 의한 혈관 파열

  • Lee, Hee-Young (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Do, Young-Soo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Young-Wook (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Hong-Suk (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Kwang-Bo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Dong-Ik (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 이희영 (성균관대학교 의과대학 삼성서울병원 영상의학과학교실) ;
  • 도영수 (성균관대학교 의과대학 삼성서울병원 영상의학과학교실) ;
  • 김영욱 (성균관대학교 의과대학 삼성서울병원 외과학교실) ;
  • 박홍석 (성균관대학교 의과대학 삼성서울병원 영상의학과학교실) ;
  • 박광보 (성균관대학교 의과대학 삼성서울병원 영상의학과학교실) ;
  • 김동익 (성균관대학교 의과대학 삼성서울병원 외과학교실)
  • Published : 2011.08.01
⟨ Previous Next ⟩

Abstract

Endovascular aneurysm repair (EVAR) has been accepted as an alternative to traditional open surgery in selected patients. Despite the minimally invasiveness of this treatment, several complications may occur during or after EVAR. Complications include endoleak, aortic dissection, distal embolism, or iatrogenic injury to the access artery. However, there are few reports on the vascular rupture caused by a molding balloon during EVAR. We report two cases of infrarenal abdominal aortic aneurysms complicated by procedure-related aortic or iliac artery rupture by the molding balloon during EVAR. In our cases, we observed suddenly abrupt increase of the diameter of the endograft during balloon inflation, because we inflated the balloon rapidly. In conclusion, careful attention must be paid during inflation of the molding balloon to prevent vascular rupture.

복부 대동맥류의 혈관 내 치료는 개복수술의 대안으로 인정받고 있다. 복부 대동맥류의 중재적 치료는 비침습적인 치료로서 장점이 있으나, endoleak, 대동맥 박리, 장골 동맥과 같은 access artery의 손상을 포함한 몇 가지 합병증이 알려져 있다. 하지만, 복부 대동맥류의 혈관 내 치료 도중 molding balloon에 의한 혈관 파열에 대해서는 보고된 바가 적다. 이번 증례에서는 복부 대동맥류의 중재적 치료에 의해 발생한 대동맥 파열 1예와 장골동맥 파열 1예를 소개하고 그 원인에 대해 고찰하고자 한다. 이 증례에서 balloon inflation을 너무 급격하게 시행하였기 때문에, balloon inflation 도중에 endo-graft의 직경이 급격히 증가하였고 이로 인하여 혈관 파열이 일어난 것으로 추정된다. 따라서, 복부 대동맥류의 혈관 내 치료시 molding balloon을 inflation할 때는 서서히 inflation하도록 특별한 주의가 요구된다.

Keywords

References

  1. Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004;351:1607-1618 https://doi.org/10.1056/NEJMoa042002
  2. Becquemin J, Bourriez A, D'Audiffret A, Zubilewicz T, Kobeiter H, Allaire E, et al. Mid-term results of endovascular versus open repair for abdominal aortic aneurysm in patients anatomically suitable for endovascular repair. Eur J Vasc Endovasc Surg 2000;19:656-661 https://doi.org/10.1053/ejvs.2000.1116
  3. Nevala T, Biancari F, Manninen H, Aho PS, Matsi P, Makinen K, et al. Finnish multicenter study on the midterm results of use of the Zenith stent-graft in the treatment of an abdominal aortic aneurysm. J Vasc Interv Radiol 2009;20:448-454 https://doi.org/10.1016/j.jvir.2008.12.410
  4. Mehta M, Sternbach Y, Taggert JB, Kreienberg PB, Roddy SP, Paty PS, et al. Long-term outcomes of secondary procedures after endovascular aneurysm repair. J Vasc Surg 2010;52:1442-1449 https://doi.org/10.1016/j.jvs.2010.06.110
  5. Drury D, Michaels JA, Jones L, Ayiku L. Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. Br J Surg 2005;92:937-946 https://doi.org/10.1002/bjs.5123
  6. Aljabri B, Obrand DI, Montreuil B, MacKenzie KS, Steinmetz OK. Early vascular complications after endovascular repair of aortoiliac aneurysms. Ann Vasc Surg 2001;15:608-614 https://doi.org/10.1007/s10016-001-0092-x
  7. Liaw JV, Clark M, Gibbs R, Jenkins M, Cheshire N, Hamady M. Update: complications and management of infrarenal EVAR. Eur J Radiol 2009;71:541-551 https://doi.org/10.1016/j.ejrad.2008.05.015
  8. Fernandez JD, Craig JM, Garrett HE Jr, Burgar SR, Bush AJ. Endovascular management of iliac rupture during endovascular aneurysm repair. J Vasc Surg 2009;50:1293-1299;discussion 1299-1300 https://doi.org/10.1016/j.jvs.2009.06.020
  9. Schlosser FJ, Gusberg RJ, Dardik A, Lin PH, Verhagen HJ, Moll FL, et al. Aneurysm rupture after EVAR: can the ultimate failure be predicted? Eur J Vasc Endovasc Surg 2009;37:15-22 https://doi.org/10.1016/j.ejvs.2008.10.011
  10. Becker GJ. Balloon angioplasty catheter. In Baum S, Pentecost MJ. Abrams' Angiography Interventional Radiology. Philadelphia: Lippincott Williams and Wilkins, 2006:187-204
  11. Sarin S, Turba UC, Angle F, Hagspiel KD, Dake MD, Matsumoto AH. Balloon catheter . In Mauro MA, Murphy KP, Thomson KR, Venbrux AC, Zollikofer CL. Image Guided Intervention. Philadelphia: ElsevierSaunders, 2008:75-84