case_images: PMC5307129_01
case_images: Computed tomography angiogram of ruptured AAA at initial presentation to the emergency department. (a) Three-dimensional reconstruction of the aneurysm sac. (b) Corresponding cross-sectional demonstrating rupture of AAA with active extravasation of contrast into the retroperitoneum.
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case_images: fig1
case_images: She presented to the emergency department with severe abdominal and back pain and hypotension and was found on CT angiography to have a contained rupture of her infrarenal aneurysm that measured 7.9 cm in diameter and had significant proximal neck and iliac angulation (Figure 1).
case_images: Intraoperative aortogram at the initial procedure showing the correct placement of the endograft and limbs bilaterally.
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case_images: PMC5307129_01_CRIVAM2017-4931282.002.jpg
case_images: fig2
case_images: At the completion arteriogram, no endoleak was identified and the distal ends of the iliac limbs were confirmed with a centimeter within the bifurcation of the iliac arteries (Figure 2).
case_images: Computed tomography angiography performed on postoperative day 2 demonstrating the proximal migration of the right endograft limb (arrow).
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case_images: fig3
case_images: Further review of the CTA demonstrated proximal migration of the right limb with a significant decrease in the length of the seal zone (Figure 3).
case_images: Intraoperative angiogram on postoperative day 2 demonstrating the acute proximal migration in the right common iliac artery resulting from the large aneurysm sac and the postimplantation change of the aortic anatomy.
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case_images: fig4
case_images: The patient was immediately transferred to the operating room and a retrograde arteriogram confirmed the right type 1b endoleak (Figure 4).
case_images: Follow-up at 12 months demonstrates a proximal migration of the left endograft limb (asterisk) on three-dimensional reconstruction of the CTA (a), leading to a type 1b endoleak as demonstrated in the aortogram (b).
case_images: CRIVAM2017-4931282.005.jpg
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case_images: fig5
case_images: Proximal migration of the left limb of the endograft was documented by comparison of the 12-month CTA images to the intraoperative arteriogram during the original repair and the subsequent CTA images at 1 and 6 months (Figure 5).
case_images: Surveillance follow-up CTA at 18 months. Three-dimensional reconstruction demonstrates the correct placement of the bilateral iliac limbs at the seal zones without evidence of endoleaks.
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case_images: PMC5307129_01_CRIVAM2017-4931282.006.jpg
case_images: fig6
case_images: A CT angiogram 6 months later confirmed complete resolution of the type 1b endoleak and a stable size of the aneurysm sac (Figure 6).