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. 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.

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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

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