Repair of Contained Rupture of an Infrarenal Aortic Aneurysm Using Autologous Superficial Femoral Vein

Abstract

Introduction

Contained ruptured abdominal aortic aneurysm (CR-AAA) refers to an acute aortic wall disruption leading to expansion of perivascular haematoma that is sealed off by peri-aortic structures. Low and middle income countries have a critical gap in managing abdominal aortic aneurysm (AAA). In Ethiopia, AAA screening is not routine and open surgical repair (OSR) using donated grafts remains the only treatment option. This case shows the first experience at Hawassa University Hospital treating CR-AAA using the superficial femoral vein (SFV) for aortic reconstruction due to lack of prosthetic grafts.

Report

A 40 year old woman presented with three months of abdominal and back pain, vomiting, and a pulsatile abdominal swelling. Imaging showed an 8 cm infrarenal CR-AAA. Due to lack of graft material, a 15 cm SFV was harvested from the left thigh and prepared as a tube graft. OSR via midline laparotomy revealed a 3 cm rupture on the right lateral aortic wall. The reversed SFV graft was anastomosed proximally to the infrarenal aorta, 3 cm below the renal artery, using a 3–0 Prolene suture. Distally, the graft was spatulated for optimal size matching and sewn with a 3–0 Prolene suture at the aortic bifurcation. The procedure lasted 10 hours. Due to the lack of a Cell Saver at the centre, 4 units of whole blood and 4 units of fresh frozen plasma were transfused. Post-operatively, the patient developed bilateral lower extremity swelling, and ultrasound revealed bilateral deep venous thrombosis. Oral anticoagulation was promptly initiated. Follow up imaging confirmed an intact anastomosis with good distal flow. The patient showed clinical improvement in leg swelling at one and three month follow ups. She is scheduled for a six month follow up and will continue regular monitoring.

Discussion

SFV use in ruptured AAA shows promise in resource limited settings. Sub-Saharan Africa's unique AAA patterns highlight specific healthcare needs. Global collaboration is vital to expand vascular care, funding, and research for better AAA treatment.