Axillobifemoral bypass and aortic embolization for the treatment of two patients with ruptured infrarenal aortic aneurysms

We report two cases of hemodynamically stable patients with contained, ruptured, juxtarenal abdominal aortic aneurysm that were both successfully treated by nonresectional therapy including axillobifemoral bypass with externally supported polytetrafluoroethylene graft, followed by coil embolization of the aneurysm sac and bilateral common iliac arteries. The patients were elderly with multiple comorbidities and complex aneurysm morphology not amenable to endovascular repair. In both cases complete thrombosis of the aneurysm was verified by computed tomography. Both patients are alive at follow-up without evidence of an increase in aneurysm size, postoperative leak, or rupture or impairment of renal function. To our knowledge these are the first reported cases in which this modality has been successfully used in patients presenting with ruptured abdominal aortic aneurysms. Earlier results of nonresectional therapy for abdominal aortic aneurysm have reported a significant incidence of postoperative aneurysm rupture and renal failure. Growing experience at our institution with nonresectional therapy for high risk patients with abdominal aortic aneurysms suggests that nonresectional therapy can be a valuable treatment modality for high risk patients including those with contained rupture of the aneurysm who are hemodynamically stable.