Endovascular Repair of a Proximal Paraanastomotic Aneurysm Using the Trombone Technique after Open AAA Repair. A Case Report and Review of the Literature.

Background: Paraanastomotic aneurysm after open surgical repair (OSR) for the treatment of abdominal aortic aneurysm (AAA) is a long-term and life threatening complication. Because prior abdominal surgery often makes open reintervention technically challenging, endovascular repair (EVAR) should be considered as an alternative. Case presentation: We report a case of a proximal anastomotic paraanastomotic aneurysm treated by endovascular means using two tube stent grafts deployed in a trombone technique, with prior embolisation of lumbal arteries. Follow-up computed tomography angiography at 1 month demonstrated complete exclusion of the aneurysm with no evidence of a persistent endoleak. Discussion: This case highlights the feasibility and safety of EVAR using the trombone technique for proximal paraanastomotic aneurysms after OSR for AAA. It also underscores the role of pre-emptive lumbar artery embolisation in reducing the risk of type II endoleak and emphasizes the importance of long-term postoperative imaging surveillance to ensure durable outcomes following both open and endovascular aneurysm repair.