).Endovascular aortic repair (EVAR) avoids the disadvantages of major surgery such as a large incision, full heparinization, extracorporeal circulation, aortic cross-clamping, interference with respiratory function, and the need for massive blood transfusions. Endoleak remains a primary complications of EVAR, however, and occurs in 20 to 25% of the patients.1,2 EVAR patients thus undergo lifelong surveillance for the presence of aneurysm expansion and endoleaks, usually via computed tomographic angiography (CTA).
2We describe the endovascular management of an enlarged aneurysmal sac 3 years after EVAR due to combined endoleak of types 1 and 3. We needed to use a fenestrated aortic cuff, a main body graft extension, and an aortouniiliac converter device to seal the leak. This case highlights the potential challenges in identifying and treating type III endoleaks.
Case ReportA 75-year-old man with a 5.5 cm infrarenal aortic aneurysm was electively treated in 2008 with an endovascular talent stent graft (Medtronic, Minneapolis, MN) measuring 28 mm in diameter. The patient course was uncomplicated and the final angiography showed no endoleak. At 3 months followup, the size of the aneurysmal sac had increased by a few millimeters, suggesting a type II endoleak. The patient was conservatively managed and kept under observation and at 1 year follow-up the aneurysmal sac size was unchanged.The patient was then lost to follow-up for 2 years but in 2011 a contrast-enhanced CT scan and angiography revealed a type Ia endoleak and 2 cm increase in the aneurysmal sac size (►Fig. 1). The proximal landing zone was too short, especially on the left side where the aneurysm neck was only 5 mm long. The patient underwent endovascular treatment where a fenestrated custom-made aortic cuff with diameter of 30 Â 58 mm (Cook, Bloomington, IN) and two fenestrations for the renal artery and a scallop for the superior mesenteric artery was placed according to the standard guidelines. Advanta stent grafts (Atrium, Netherlands) of 6 Â 22 mm on the right side and 7 Â 22 mm on the left side were placed in the renal arteries using a left femoral route. The guide wire was placed in the superior mesenteric artery through the left brachial artery to allow rapid arterial access in the event of
AbstractEndovascular aortic repair (EVAR) has become preferable treatment of abdominal aortic aneurysms because of proven mortality reduction as well as complications reduction compared with open surgery. Endoleak remains a primary complication of EVAR, however, and occurs in 20 to 25% of the patients. EVAR patients thus undergo lifelong surveillance for the presence of aneurysm expansion and endoleaks usually via computed tomographic angiography. We describe the endovascular management of an enlarged aneurysmal sac size 3 years after EVAR due to combined endoleak of types 1 and 3. We needed to use a fenestrated aortic cuff, a main body graft extension, and an aortouniiliac converter device to seal the leak. This case highlights the potential challenges in id...
