Tratamiento endovascular de un aneurisma de aorta abdominal con rotura contenida

Introduction. Chronic contained rupture of an aneurysm in the infrarenal abdominal aorta is an infrequent presenting symptom; yet, treatment of this condition by endovascular means is even rarer. Case report. We studied the case of a 70-year-old male who was transferred from another hospital, where he had been admitted due to nephrolithiasis, because of chronic lower back pain that had exacerbated in the previous 24 hours, although the patient displayed haemodynamic stability. This patient was a smoker, with severe obstructive pulmonary disease, advanced alcoholism and chronic liver disease. A CAT scan of the thorax-abdomen-pelvis revealed the presence of an infrarenal abdominal aortic aneurysm with a contained rupture in the retroperitoneum. Given the patient's haemodynamic stability and his associated pathologies, the decision was made to perform an endovascular exclusion, since the anatomical characteristics of the aneurysm favoured such an intervention. The patient was submitted to surgery 16 hours after admission to perform the above-mentioned exclusion, and no intraoperative incidences were recorded. The patient was discharged from hospital five days after the operation, free of symptoms, and the control CAT scan showed that the procedure remained patent and free of endoleaks. Nine months after the intervention no changes have taken place in the patient. Conclusions. The chronic contained rupture of an abdominal aortic aneurysm is clearly a life-threatening situation that requires urgent-preferential treatment and has a mortality rate of between 15% and 20%. The chances of applying endovascular treatment depend on a number of factors including the patient's state of health and whether the aneurysm has favourable anatomical characteristics or not. Other essential factors are the availability of resources such as a stock of stents, a radiological operating theatre and staff with suitable training in the elective endovascular repair of aneurysms. [ANGIOLOGÍA 2005; 57: 247-52]