Vascular surgery in rural areas: abdominal aortic aneurysm surgery with prosthesis in a tertiary hospital in Haiti: a case report
DOI:
https://doi.org/10.18203/2349-2902.isj20262472Keywords:
Abdominal aortic aneurysm, Rural areas, Vascular surgeryAbstract
Open surgery was replaced in the 1990s by endovascular repair (EVAR), a less invasive method that benefits many patients. However, he remains inaccessible in resource-limited countries, where surgery faces many obstacles. This article explores a case of aorto-iliac aneurysm in a young adult treated in a rural area with limited resources, highlighting the challenges and possibilities of surgical interventions performed under restrictive conditions. A 43-year-old hypertensive man with a 5-year history of abdominal mass presented with abdominal pain and mass. Examination revealed a left-sided pulsatile abdominal mass with thrill. Ultrasound showed a 71.8 mm infrarenal aorto-iliac aneurysm with 39 mm common iliac artery diameter. He underwent successful open repair with a bifurcated prosthesis after stabilization and optimization. CT angiography is the gold standard for diagnosing abdominal aortic aneurysm, allowing accurate assessment and planning. In our context, planning was based on Doppler ultrasound due to limited access to CT angiography. Preparing for open repair of abdominal aortic aneurysms (AAA) also involves optimizing comorbidities, a functional blood bank, and invasive monitoring. In this case, limitations included a lack of CT scanning, minimal blood resources, no invasive intraoperative hemodynamic monitoring and reports indicated that a Doppler ultrasound confirmed the success of the graft. These shortcomings theoretically increase surgical risk, reflecting realities in resource-limited hospitals. This case shows open AAA surgery is feasible in constrained environments with good preparation and adaptation. Although EVAR is effective, open surgery remains crucial in certain situations.
References
Wanjari MB, Mendhe D, Wankhede P. Abdominal Aortic Aneurysm- A Case Report. J Pharm Res Int. 2021;(09):265-9.
Baas AF, Kranendonk SE. Abdominal aortic aneurysm. Clinical Cardiogenetics. Published online 2011:423-35.
Ayraler A. Abdominal aortic aneurysm: A case report. Med Int (Lond). 2023;3(5):43-5.
Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP. Ultrasonography screening for abdominal aortic aneurysms: A systematic evidence review for the U.S. preventive services task force. Ann Intern Med. 2014;160(5):321-9.
Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal aortic aneurysms: Single centre randomised controlled trial. Br Med J. 2005;330(7494):750-2.
Wu VS, Caputo FJ, Quatromoni JG, Kirksey L, Lyden SP, Rowse JW. Association between socioeconomic deprivation and presentation with a ruptured abdominal aortic aneurysm. J Vasc Surg. 2024;79(1):44-54.
Aortic DA. Case 16789 Case Report of Incidentally Detected Abdominal Aortic. Eurorad. 2020.
de Boer NJ, Knaap SFC, de Zoete A. Clinical detection of abdominal aortic aneurysm in a 74-year-old man in chiropractic practice. J Chiropr Med. 2010;9(1):38-41. doi:10.1016/j.jcm.2009.12.002
Brady AR, Thompson SG, Fowkes FGR, Greenhalgh RM, Powell JT. Abdominal aortic aneurysm expansion: Risk factors and time intervals for surveillance. Circulation. 2004;110(1):16-21.
Chatterjee T, Qasem A, Piening NM, Patel G. A Case of Gigantic Unruptured Abdominal Aneurysm Successfully Treated With Endovascular Repair (EVAR). Annals of Internal Medicine: Clin Cases. 2023;2(1):2022-24.
Patel SN, Kettner NW. Abdominal Aortic Aneurysm Presenting as Back Pain to a Chiropractic Clinic: A Case Report. J Manipulative Physiol Ther. 2006;29(5):409.e1-e7.
Hopkins NFG. Abdominal aortic aneurysms. Br Med J (Clin Res Ed). 1987;294(6575):790-1.
Fink HA, Lederle FA, Roth CS, Bowles CA, Nelson DB, Haas MA. The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med. 2002;160(6):833-6.
Droz NM, Miner J, Pecchioni L. An 18-cm unruptured abdominal aortic aneurysm. J Vasc Surg Cases Innov Tech. 2017;3(1):16-9.
Hu DK, Pisimisis GT, Sheth RA. Repair of abdominal aortic aneurysms: Preoperative imaging and evaluation. Cardiovasc Diagn Ther. AME Publishing Company. 2018;8:S157-67.
Fazlalizadeh H, Khan MS, Fox ER. Closing the Last Mile Gap in Access to Multimodality Imaging in Rural Settings: Design of the Imaging Core of the Risk Underlying Rural Areas Longitudinal Study. Circ Cardiovasc Imaging. 2024;17(2):132-43.
Pastuszak Z, Stȩpień A, Kordowska J, Rolewska A, Galbarczyk D. Brain strokes related to aortic aneurysma-The analysis of three cases. Open Medicine (Poland). 2017;12(1):50-61.
Wenham MPAPW, Whitaker SC, Gregson RHS, Hopkinson BR. Common Iliac Artery Aneurysms in Patients with Abdominal Aortic Aneurysms. 1998;257:255-7.
Lederle FA. Abdominal Aortic Aneurysm-Open versus Endovascular Repair. New England J Med. 2004;351(16):1677-9.
Yei K, Mathlouthi A, Naazie I, Elsayed N, Clary B, Malas M. Long-term Outcomes Associated with Open vs Endovascular Abdominal Aortic Aneurysm Repair in a Medicare-Matched Database. JAMA Netw Open. 2022;5(5):E2212081.
Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial. JAMA. 2009;302(14):1535-42.
Maalouf E. Best practice guidelines. Early Hum Dev. 2005;81(2):131.
Manchella MK, Marcaccio CL, Jabbour G, Yang S, Schermerhorn ML, Secemsky EA, et al. Disparities in endovascular repair of ruptured abdominal aortic aneurysms among Medicare beneficiaries. JVS-Vascular Insights. 2025;3:100196.
Downloads
Published
How to Cite
Issue
Section
