Endovascular treatment for Type III Endoleak by disconnection of aortic stent graft components

Abstract

Endovascular repair of abdominal aortic aneurysms (EVAR) has expanded in recent years. Compared to surgical repair, EVAR is associated with lower 30-day morbidity and mortality although it has higher reintervention rates due to the presence of endoleaks during follow-up. We put forward the case of an 81-year-old patient who, four years after EVAR, presented with a type 3 endoleak owing to disconnection between the main body and the proximal cuffs of the endograft. Emergency endovascular treatment was performed via both surgical and percutaneous femoral access. The endograft components were threaded through a catheter and hydrophilic wire, respectively, and then replaced with two Lunderquist wires, achieving acceptable alignment. Finally, a thoracic endograft was implanted with sufficient overlap in the disconnection area, thus sealing the endoleak. The patient progressed without major complications and was discharged 48 hours after the procedure.