Purpose: Pseudoaneurysms of the abdominal aorta secondary to pancreatitis are an extremely rare clinical entity, however, can result in life threatening complications. We describe a chimney endovascular aneurysm repair (Ch-EVAR) for an acute pancreatitis related para-visceral aortic pseudoaneurysm. Method: Prospective data collected from subject. Results: We present the case of a 23-year-old female who underwent a successful salvage Ch-EVAR for a ruptured suprarenal, paravisceral pseudoaneurysm secondary to acute pancreatitis. In the setting of haemodynamic instability (small measured (14.1x14mm) aortic dimensions) and the off-the-shelf grafts available at the time, the aortic limb may have been oversized, leading to graft crowding and thrombosis, noted on a CT aortogram day 75 post-operatively. This was managed with a heparin infusion initially and she went on to have an explant of the Ch-EVAR limbs with minimal dissection/exposure during her definitive open pancreatectomy and splenectomy. Axillary artery exposure was obtained to facilitate placement of a Coda balloon in the distal thoracic aorta. A transverse, supracoeliac aortotomy was performed and the aortic, coeliac and SMA stents were removed. The site of previous aortic pseudoaneurysm was inspected with no evidence of bleeding. The patient was successfully discharged to rehabilitation 3.5 months post Ch-EVAR insertion. CT imaging prior to discharge revealed no evidence of aortic pseudoaneurysm as well as patent coeliac, SMA and renal arteries with no evidence of stenosis in the aorta or vessels of the lower limbs. Conclusion: This case demonstrates feasibility of utilising off-the-shelf components for a Ch-EVAR to temporise life threatening haemorrhage prior to definitive surgical management of pancreatitis. Further studies are warranted to elucidate the long-term viability of Ch-EVAR grafts in the suprarenal, paravisceral aortic position.

Introduction Renal artery aneurysm (RAA) is uncommon and is associated with an increased rate of rupture during pregnancy. Management can become particularly challenging when a large RAA is discovered during pregnancy. We present a case of an incidental large RAA discovered in a pregnant patient. Case summary A 29-year-old, 25-week pregnant female was referred for an incidentally discovered right renal aneurysm during renal tract ultrasound. Her past history included a congenital single kidney, coeliac disease and an uncomplicated C-section 5 years ago. Magnetic resonance venography confirmed a 3x2.3cm hilar aneurysm at the level of the renal artery bifurcation with the aneurysm neck poorly visualized. Challenge How and when will you repair the aneurysm, safely preserving both mother and child?

A discussion through the Challenge the Experts format on the management of recurrent central venous stenosis in the context of ongoing access requirements.

Challenge the Experts presentation I will be presenting a case of a spontaneous non-A non-B aortic dissection with involvement of an artery of lusoria (abhorrent right subclavian artery), in whom the main concern is bowel ischaemia. This will be a powerpoint presentation.