Complex endoleak treatment after failed endovascular aortic repair

Abstract

Background: Endovascular aneurysm repair (EVAR) has created new possibilities for patients with abdominal aortic aneurysms (AAAs), and in recent years it has become tremendously popular. Use of EVAR in selected groups of patients allows mortality and morbidity to be reduced in comparison to open repair. However, complications such as endoleaks (ELs) can be of great concern and warrant urgent therapy to prevent sac rupture.

Case presentation: The case report presents urgent endovascular treatment of a high-risk type IA EL in a polymorbid 68-year-old patient 7 years after primary EVAR. The principle of treatment was parallel implantation of the proximal SG extension with the renal SG into the right renal artery (chimney technique). The subsequent type II collateral EL was treated by direct transabdominal AAA sac puncture and thrombin embolization.

Conclusion: EL can be a cause for urgent intervention, but specific anatomic features often require specialized SG types which are not readily available. The chimney technique allows the use of immediately available stent grafts to address endoleak in the setting of impending abdominal aneurysm rupture.

Fig. 1

Type IA endoleak presenting 7 years after primary therapy (CTA (a), DSA (b))

Fig. 2

Chimney technique. Dilatation of the renal stent graft after deployment of the proximal aortic extension (DSA) (a). Elimination of type IA endoleak with a tubular extension and stent graft inserted into the solitary renal artery (DSA (b), CTA (c))

Fig. 3

Type II endoleak demonstrated in the dorsal aspect of the aneurysm sac (CTA) (a). Transabdominal thrombin application was used to embolize type II endoleak (US) (b)