Fabric Tears of Stent Graft Often Exist Among Aneurysm Sac Expansion After Endovascular Abdominal Aortic Aneurysm Repair

Abstract

Introduction: Although type IIIb endoleaks caused by fabric tears are rare in endovascular abdominal aneurysm repair (EVAR) -related complications, they can lead to serious complications, including aneurysm expansion and eventual aneurysm rupture. Under the direct inspection in late open surgery for aneurysm sac expansion by persistent type II endoleak, we observed not only type II endoleak from patent lumber arteries but also type IIIb endoleak by fabric tears of an endovascular stent graft in several cases. There may be other types of endoleak, especially type IIIb, not diagnosed in pre-operation. There may be more type IIIb endoleak than we consider among aneurysm expansion by type II endoleak. Methods: Between January 2009 and December 2017, 182 patients underwent EVAR in our institution. Secondary intervention for sac diameter expansion by persistent type II endoleak was performed in 17 patients (9.3%). We examined peri-operative characteristics of the 17 patients. Results: For 16 out of 17 patients with type II endoleak at pre-secondary intervention, open surgery method was performed. Definitive diagnoses of endoleak type with intraoperative findings were type II only in 10 patients, type II and type IIIb in 6 patients (38%). The devices used for the 6 patients who diagnosed type II and type IIIb were Zenith 2, Excluder 2, Endurant 1 and AFX 1. Operative procedures for 10 type II only patients were, bifurcated graft repair in 2 patients, and open ligation of lumber arteries in 8 patients. For type II and type IIIb patients, open ligation of lumber arteries was performed for type II endoleak, then for type IIIb procedure, a suture hemostasis was selected in 4 patients, and an additional leg insertion in 2 patients. All patients' postoperative course was uneventful, and in-hospital death was 0 patient. Conclusion: Our experience demonstrated that there is a possibility of complex condition with not only type II endoleak but also type IIIb endoleak in patients with type II endoleak in pre-operative diagnosis. Although type IIIb endoleak is often difficult to detect, there were much more type IIIb endoleak than we consider. We should note that type IIIb endoleak caused by fabric tears of stent graft is present among sac expansion after EVAR. Disclosure: Nothing to disclose