Aneurysm sac enlargement 16 years after endovascular aortic aneurysm repair due to late type IIIb endoleak: A case report

Murakami, Yuri; Toya, Naoki; Fukushima, Soichiro; Ito, Eisaku; Akiba, Tadashi; Ohki, Takao

doi:10.1016/j.ijscr.2018.06.030

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Type IIIb endoleak is a highpressure, high-risk leak [2] that leads to rapid growth of the aneurysmal sac and rupture [3]. Type IIIb endoleaks have been reported to occur as early as during operation to beyond 16 years postoperative, emphasizing the need for continuous surveillance [4,5].…”

Section: Introductionmentioning

confidence: 99%

Type IIIb endoleak due to stent suture line fabric breakage in the Endurant stent graft: a case report

et al. 2022

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Background Early type IIIb endoleak is a very rare complication of endovascular aneurysm repair (EVAR). Case presentation An 87-year-old man was diagnosed with infrarenal abdominal aortic aneurysm. The patient underwent EVAR using the Endurant stent graft. Postoperative color duplex ultrasound revealed a regular row of pulsatile blood flow from the main body and left leg. The blood flow appeared to be bleeding from the stent suture lines because of its regularity. Type IIIb endoleak was suspected due to stent suture line fabric breakage but was not treated surgically or endovascularly because of the patient’s poor general health status. Six months later, contrast-enhanced CT demonstrated a deformation and enlargement of the aneurysm sac as well as an oozing of the contrast medium on the main body and left limb. Thereafter, he died of a subdural hematoma due to a fall. Autopsy showed no visible abnormal erosion or holes on the graft fabric, suggesting that suture line fabric breakage may have existed during the manufacturing process. Conclusions Although rare, type IIIb endoleaks can occur even in the perioperative period after EVAR. Early type IIIb endoleaks may not resolve spontaneously and should be treated promptly, if possible.

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Section: Introductionmentioning

confidence: 99%

Type IIIb endoleak due to stent suture line fabric breakage in the Endurant stent graft: a case report

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…9 To the best of our knowledge, there have been reported on 16 previous reports of type IIIb endoleak with the Zenith stent graft; it occurred early or late (0 to 228 months) after EVAR. [6][7][8][9][10][11][12][13][14][15] The Zenith and other stent grafts, in which self-expanding stainless steel Z-shaped stents are attached with surgical sutures to a woven polyester graft, may be susceptible to type IIIb endoleak; the mechanism of type IIIb endoleak in these stent grafts is deterioration of graft fabric in conjunction with stent sutures. Minor holes in conjunction with stent sutures should not be of any clinical importance, whereas a large hole or tear in the fabric can represent a major failure of the stent graft, as seen in our cases.…”

Section: Discussionmentioning

confidence: 99%

Type IIIb Endoleak After Endovascular Aneurysm Repair Using the Zenith Stent Graft

Nishibe

Iwahashi

Kamiya

et al. 2019

Vasc Endovascular Surg

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We present 3 cases of type IIIb endoleak after endovascular aneurysm repair (EVAR) using the Zenith stent graft system. Type III endoleak, like type I endoleak, is a high-pressure, high-risk leak that increases sac pressure up to or even above arterial pressure, and is associated with an increased frequency of open conversions or risk of aneurysm rupture. Type IIIb endoleak is rare but there is much concern that the incidence of type IIIb endoleak is likely to increase hereafter; the mechanism of type IIIb endoleak is deterioration of graft fabric in conjunction with stent sutures. Type IIIb endoleak is difficult to diagnose before rupture. The possibility of type IIIb endoleak should be highly suspected when the continued growth of an excluded aneurysm sac without direct radiologic evidence is observed during follow-up. Type IIIb endoleak can be repaired by relining of the stent graft with additional stent grafts.

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“…We previously reported the clinical outcomes of endovascular repair for aortic disease including aortic dissection, and complex aortic aneurysms [1], [2]. However, we sometimes experience an additional treatment even after EVAR, caused by an endoleak (EL), endograft infection, or endograft material deterioration [3], [4], [5]. For further treatment improvement, a reproducible large animal aortic disease model is required for investigating new therapeutic device and interventions.…”

Section: Introductionmentioning

confidence: 99%

A reproducible swine model of a surgically created saccular thoracic aortic aneurysm

et al. 2021

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A reproducible swine thoracic aortic aneurysm (TAA) model is useful for investigating new therapeutic interventions. We report a surgical method for creating a reproducible swine saccular TAA model. We used eight female swine weighing 20-25 kg (LWD; ternary species). All procedures were performed under general anesthesia and involved left thoracotomy. Following aortic cross-clamping, the thoracic aorta was surgically dissected and the media and intima were resected, and the dissection plane was extended by spreading the outer layer for aneurysmal space. Subsequently, only the adventitial layer of the aorta was sutured. At 2 weeks after these procedures, angiography and computed tomography (CT) were performed. After follow-up imaging, the model animals were euthanized. Macroscopic, histological, and immunohistological examinations were performed. All model animals survived, and a saccular TAA was confirmed by follow-up imaging in all cases. The mean length of the shorter and the longer aortic diameter after the procedure were 14.01 ± 1.0 mm and 18.35 ±1.4 mm, respectively (p < 0.001). The rate of increase in the aortic diameter was 131.7 ±13.8 %, and the mean length of aneurysmal change at thoracic aorta was 22.4±1.9 mm. Histological examination revealed intimal tears and defects of elastic fibers in the media. Immunostaining revealed MMP-2 and MMP-9 expressions at the aneurysm site. We report our surgical method for creating a swine saccular TAA model. Our model animal may be useful to investigate new therapeutic interventions for aortic disease.

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Aneurysm sac enlargement 16 years after endovascular aortic aneurysm repair due to late type IIIb endoleak: A case report

Cited by 5 publications

References 12 publications

Type IIIb endoleak due to stent suture line fabric breakage in the Endurant stent graft: a case report

Type IIIb endoleak due to stent suture line fabric breakage in the Endurant stent graft: a case report

Type IIIb Endoleak After Endovascular Aneurysm Repair Using the Zenith Stent Graft

A reproducible swine model of a surgically created saccular thoracic aortic aneurysm

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