Successful repair of a type 2 endoleak with coiling of inferior mesenteric artery

One of the most common complications of endovascular aneurysm repair (EVAR) is type 2 endoleak. We describe a patient who presented with a recurrent endoleak despite initial intervention and was successfully treated with coil embolization of the inferior mesenteric artery (IMA).

A 63-year-old Caucasian male was found to have a 7.5 cm abdominal aortic aneurysm (AAA) during a routine ultrasound of the kidneys. The patient successfully underwent EVAR with exclusion of the aneurysm sac. A computed tomographic (CT) scan was performed 30 days after the procedure, and showed presence of a large type 1a endoleak with slight enlargement of the sac. The endoleak was successfully repaired with 2 extension cuffs which resulted in resolution of the endoleak. A few months later, another CT scan was performed that showed a type 2 endoleak without enlargement of the sac; however, there was no reduction in the size of the sac. Multiplanar reconstruction was used and a small branch connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA) through the marginal artery was found. A selective angiogram of the SMA was performed that showed filling of the aneurysm sac. A microcatheter was advanced through the SMA and marginal artery into the IMA. The IMA was occluded with coil embolization, resulting in resolution of the endoleak.

Our case describes a patient who initially underwent treatment for type 1a endoleak and subsequently developed type 2 endoleak that was successfully treated with coil embolization of the IMA.