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Endovascular Repair of a Symptomatic Aneurysm 5 Years after AneuRx Exclusion: Off-Label Use of Reversed Talent Aortomonoiliac Stent-Grafts

Purpose: To describe the off-label use of 2 Talent aortomonoiliac devices to repair a symptomatic 72-mm abdominal aortic aneurysm (AAA) 5 years after AneuRx repair in a patient who had no follow-up. Case Report: A 68-year-old man was referred to our hospital with a history of severe abdominal and back pain for 3 days. Five years earlier, he received an AneuRx stent-graft for an asymptomatic 51-mm infrarenal AAA, but he had not appeared for scheduled follow-up examinations. Computed tomographic angiography (CTA) showed a 72-mm AAA with bilateral common iliac aneurysms of 25 and 24 mm, respectively. The aortic segment of the AneuRx stent-graft appeared to be migrated distally by at least 20 mm; however, no type I endoleak was visible. Both distal iliac ends of the AneuRx stent-graft were migrated proximally and appeared to be floating free in the aneurysm sac, causing a bilateral type I endoleak distally. At operation, a 28-mm Talent aortic extension was inserted and dilated to cover the proximal migration zone. A Talent 28X16X126-mm aortomonoiliac stent-graft was reversed, re-installed into the deployment device, and deployed into the right AneuRx limb. The same procedure was followed on the left side, with deployment of a reversed 26X16X126-mm aortomonoiliac device. Angiography showed a fully excluded aneurysm with good anchoring of both stent-grafts. The patient was discharged on the third postoperative day in good general condition, without evidence of endoleak. At 3 and 6 months, CTA demonstrated no change in the position of the stent-graft and no signs of endoleak. Conclusion: The off-label use of a reversed aortomonoiliac stent-graft is an easy alternative to the well-known technique of a distally placed aortic extension cuff and also eliminates the risk of a type III endoleak.