Abstract
A 73 year old man who underwent an elective EVAR procedure in 2014 for an infrarenal AAA presented two years later with a type IA endoleak. The CTA showed a distal migration of the proximal part of the stent graft resulting in a type IA endoleak. In order to treat this new diagnosed endoleak an endovascular repair using chimney technique (with a snorkel-stent graft in the renal artery-bilaterally) with proximal extension of sealing zone with an endovascular aortic cuff has been undergone with implantation of a stent graft in the right renal artery as a periscope and a chimney in the left renal artery. Subsequently, an Endurant II Aortic Cuff was implanted. The whole procedure was performed using CO2 instead of iodinated contrast medium. In the 5 month follow-up with abdominal ultrasonography no endoleak could be identified with stabilization of aneurysmal sac diameter. The use of chimney technique adds an additional tool to the armamentarium of endovascular surgeon to deal with the complex type IA endoleaks Keywords: Abdominal aneurysm , CO2 angiography , chimney-graft technique, type IA endoleak, periscope technique.
Highlights
The abdominal aortic aneurysm (AAA) is associated with a high risk of rupture and mortality [1]
The real incidence of type I endoleak is not specified but according to the data of The European Multicenter Experience of Endovascular Aortic Aneurysm Repair with the Endurant Stent-graft, the endoleak type I has been detected in 2.2% of patients in the first year after endovascular aortic aneurysm repair (EVAR) procedure [2]
We report the use of chimney-graft technique to treat a type IA endoleak in a AAA-patient treated previously with an EVAR procedure
Summary
The abdominal aortic aneurysm (AAA) is associated with a high risk of rupture and mortality [1]. The endovascular aortic aneurysm repair (EVAR) became the key method of treatment of infrarenal AAA. The real incidence of type I endoleak is not specified but according to the data of The European Multicenter Experience of Endovascular Aortic Aneurysm Repair with the Endurant Stent-graft, the endoleak type I has been detected in 2.2% of patients in the first year after EVAR procedure [2]. Treatment options for the type IA endoleak after EVAR are open conversion surgery and more frequently including endovascular procedures and one of the options is to extend the proximal sealing zone of the implanted stent graft. We report the use of chimney-graft technique to treat a type IA endoleak in a AAA-patient treated previously with an EVAR procedure
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