Surgical treatment of endotension after chimney endovascular repair of a symptomatic juxtarenal aneurysm.

Donas KP, Marchiori E, Inchingolo M, Torsello G.

Abstract

Endoleaks and persistent aneurysm sac expansion, also known as endotension, remain the Achilles heel of EVAR. The present article reports on a surgical treatment of one patient with endotension after chimney EVAR for a symptomatic juxtarenal aortic aneurysm. The surgical exploration revealed no signs of inflammation or infection and excluded any endoleak, confirming the term "endotension". After one year was confirmed the absence of sac expansion or endoleak, with stable maximum diameter. Regarding therapeutic options, a nonoperative approach is recommended in asymptomatic patients. However, the management strategy for sac expansion without evidence of endoleaks as in case of endotension remains controversial.