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Case Reports
. 2020 Apr 15:47:43-46.
doi: 10.1016/j.ejvsvf.2020.04.001. eCollection 2020.

Diagnostic Colour Duplex Ultrasound for Type IIIb Endoleak

M Alyssa Varsanik  1 , Luka Pocivavsek  2 , Trissa Babrowski  2 , Ross Milner  2
Affiliations
Case Reports

Diagnostic Colour Duplex Ultrasound for Type IIIb Endoleak

M Alyssa Varsanik et al. EJVES Vasc Forum. .

Abstract

Introduction: This report presents the treatment of an aortic endovascular aneurysm repair (EVAR) device failure, focusing on the use of colour duplex ultrasound (CDUS) to diagnose and confirm effective treatment of a type IIIb endoleak.

Report: An 89 year old man with a history of EVAR was transferred to the authors' centre with complaints of abdominal pain and a pressure sensation behind the umbilicus. A previously stable 11 cm aneurysm sac was visualised on computed tomography angiography in addition to a newly suspected type IIIb endoleak, which was confirmed via CDUS. He underwent successful endovascular repair with a stent across the limb defect. The patient was discharged uneventfully and was followed for surveillance.

Discussion: Type IIIb endoleak is an underreported complication after EVAR. CDUS of type IIIb endoleak aided in localisation and characterisation of the graft failure, and confirmed successful endovascular treatment of the endoleak defect in the side limb. Locating the point of graft failure using CDUS preceding endovascular repair of type IIIb endoleaks guides interventions and repair outcomes. It is a rare opportunity to report a case of acute type IIIb endoleak with CDUS that definitively localised an endograft defect.

Keywords: Colour duplex ultrasound; Endoleak; Endovascular repair.

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Figures

Figure 1
Figure 1
Computed tomography angiography at patient presentation demonstrating contrast extravasation (white arrow) in the right limb of the endovascular aneurysm repair device, representing concern for new type IIIb endoleak.
Figure 2
Figure 2
Turbulent flow (63 cm/sec) in the aneurysm sac suspicious of endoleak (A). Type III endoleak with flow jet in right limb of endovascular aneurysm repair device (arrow, B). Colour flow demonstrates positive velocity through endoleak (C–E). Peak velocity of flow jet from right limb is 450 cm/sec (F).
Figure 3
Figure 3
Endoleak extravasation from right limb of endovascular aneurysm repair device confirmed on angiogram (arrow, A). No endoleak extravasation from right limb after stent graft placement (B).
Figure 4
Figure 4
Absence of turbulent flow around body of stent graft confirms treatment of endoleak (A). Unidirectional laminar flow within the right limb borders with no evidence of flow jet wave outside the limb confirms successful treatment of type III endoleak (B, C).
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