Life-Saving Endovascular Management of a Ruptured Iatrogenic Infrarenal Aortic Pseudoaneurysm

Traumatic injuries to the aorta are rare but carry a high risk of mortality. In particular, penetrating injuries to the abdominal aorta pose a significant challenge as many patients do not survive long enough to reach the hospital. Although vascular complications during laparoscopic surgery are rare, they can occur during pneumoperitoneum or trocar insertion. Endovascular stenting is an established treatment for blunt aortic injuries, but its use in the management of penetrating injuries is less well-defined. We present the case of a 68-year-old woman who developed hypovolemic shock during an attempted laparoscopic cholecystectomy. The procedure was converted to open due to hemodynamic instability. Intraoperative findings revealed a retroperitoneal hematoma, and no active source of bleeding could be identified. Given the transient stabilization of the patient and the absence of visible ongoing bleeding, a conservative approach was adopted. Several months later, the patient experienced an episode of syncope, which prompted further imaging and led to the diagnosis of a ruptured iatrogenic abdominal aortic pseudoaneurysm. The patient was treated with endovascular deployment of a BeGraft endoprosthesis, and hemodynamic stability was successfully restored.