Recurrent Abdominal Aortic Aneurysm Secondary to Type II Endoleak

Abstract

Prevention of aneurysm rupture is the primary aim of the elective treatment of abdominal aortic aneurysm (AAA). The concept of aneurysm recurrence following successful surgical repair is a relatively new concept that has accompanied the development of endovascular repair of AAA (EVAR). Following open repair the chance of aneurysm recurrence was thought to be minimal, except at a later stage when aneurysmal dilatation of aorta can occur above or below the interposition graft. Endovascular aneurysm repair (EVAR) is however complicated by endoleaks and device migration, which can cause persistent perfusion of the aneurysm sac, leading to recurrent AAA. Thus early enthusiasm for endovascular aneurysm repair (EVAR) has been marred by sobering reports of aneurysm sac expansion and rupture despite apparently successful initial treatment. These catastrophes have largely been attributed to graft migration and endoleak. Thus regular follow up of patients is needed and EVAR is still in experimental stage. The employment of adjuvant percutaneous radiological techniques such as coil embolisation of a patent inferior mesenteric artery or lumbar vessels, either prior to, or during deployment of an endovascular device, have been utilized in an attempt to reduce the incidence of this complication. However, despite regular follow-up of EVAR cases, interval endoleaks do occur. Many of these can be treated by further endovascular or open surgical intervention. Despite