Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014;5(10):739-42.
doi: 10.1016/j.ijscr.2014.08.008. Epub 2014 Aug 26.

External aortic wrap for repair of type 1 endoleak

Anastasia Dean  1 , Swee Leong Yap  2 , Venu Bhamidipaty  2 , Franklin Pond  2
Affiliations

External aortic wrap for repair of type 1 endoleak

Anastasia Dean et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Type 1 endoleak is a rare complication after endovascular abdominal aortic aneurysm repair (EVAR) with a reported frequency up to 2.88%. It is a major risk factor for aneurysmal enlargement and rupture.

Presentation of case: We present a case of a 68 year old gentleman who was found to have a proximal type 1 endoleak with loss of graft wall apposition on routine surveillance imaging post-EVAR. An initial attempt at endovascular repair was unsuccessful. Given the patient's multiple medical co-morbidities, which precluded the possibility of conventional graft explantation and open repair, we performed a novel surgical technique which did not require aortic cross-clamping. A double-layered Dacron wrap was secured around the infra-renal aorta with Prolene sutures, effectively hoisting the posterior bulge to allow wall to graft apposition and excluding the endoleak. Post-operative CT angiogram showed resolution of the endoleak and a stable sac size.

Discussion: Several anatomical factors need to be considered when this technique is proposed including aortic neck angulation, position of lumbar arteries and peri-aortic venous anatomy. While an external wrap technique has been investigated sporadically for vascular aneurysms, to our knowledge there is only one similar case in the literature.

Conclusion: Provided certain anatomical features are present, an external aortic wrap is a useful and successful option to manage type 1 endoleak in high-risk patients who are unsuitable for aortic clamping.

Keywords: AAA; Dacron graft; EVAR; Endoleak.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
CT scan sagittal slice, showing the infra-renal AAA prior to initial endovascular repair.
Fig. 2
Fig. 2
CT scan coronal slice, showing the infra-renal AAA prior to initial endovascular repair.
Fig. 3
Fig. 3
CT scan sagittal slice, showing a type 1 endoleak post-endovascular repair of AAA with a Zenith® bifurcated device. Note the contrast blush posteriorly into the aneurysmal sac and loss of graft-wall apposition.
Fig. 4
Fig. 4
CT scan coronal slice, after the initial endovascular attempt to repair type 1 endoleak with an Endurant® cuff and the Palmaz® stent. Note the position of the Palmaz® stent across the supra-coeliac aortic clamp zone.
Fig. 5
Fig. 5
CT abdomen, sagittal view, after the external wrap. Note the posterior aortic wall has been hoisted up against the Zenith® graft with resolution of the type 1 endoleak.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Albuquerque F.C., Jr., Tonnessen B.H., Noll R.E., Jr., Cires G., Kim J.K., Sternbergh W.C., III Paradigm shifts in the treatment of abdominal aortic aneurysm: trends in 721 patients between 1996 and 2008. J Vasc Surg. 2010;51(6):1348–1352. - PubMed
    1. van Marrewijk C., Buth J., Harris P.L., Norgren L., Nevelsteen A., Wyatt M.G. Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: the EUROSTAR experience. J Vasc Surg. 2002;35(3):461–473. - PubMed
    1. Younis G., Messner G., Gregoric I., Krajcer Z. Aortic wrap as a novel technique of type I endoleak repair. Ann Vasc Surg. 2006;20(September (5)):690–695. - PubMed
    1. Kudo T., Kao K.K., Nelson S.D., Reil T.D., Haas B.T., Ahn S.S. Laparoscopic aortic reinforcement and endovascular graft replacement in swine: a new external wrap. J Vasc Surg. 2005;41(6):1031–1035. - PubMed
    1. Middleman I.C., Drey N.W. Cellophane wrapping of an abdominal aortic aneurysm. Surgery. 1951;29(6):890–894. - PubMed