Zenith Cook limb type IIIB endoleak causing aneurysm rupture five years after EVAR
Peter Mezes1, Morad Sallam2, Athanasios Diamantopoulos3
1Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK North Bristol NHS Trust, Department of Radiology, Southmead Hospital, Bristol, UK drpetermezes@gmail.com.
Vascular
|September 4, 2014
Summary
Type III endoleaks, a rare complication of endovascular aneurysm repair, can cause late rupture. This case details endovascular treatment for a ruptured abdominal aortic aneurysm due to a graft fabric defect (type IIIB endoleak).
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Aneurysm
Background:
- Type III endoleaks are infrequent late complications following endovascular abdominal aortic aneurysm repair (EVAR).
- These leaks occur due to modular component disconnection (Type IIIA) or graft fabric defects (Type IIIB), leading to sac pressurization.
- Late complications necessitate ongoing surveillance and understanding of potential failure modes.
Observation:
- A patient presented with a ruptured infrarenal aortic aneurysm five years post-elective EVAR.
- The rupture was attributed to a Type IIIB endoleak, specifically suspected graft material erosion of the contralateral limb.
- This represents the first reported instance of late aneurysm rupture caused by a fabric defect in a Cook Zenith graft limb.
Findings:
- Successful endovascular treatment was performed for the ruptured aneurysm.
- The Type IIIB endoleak stemmed from graft material erosion, a rare but serious complication.
- Device migration, even minimal, can compromise the graft's integrity over time.
Implications:
- This case underscores the critical importance of proximal fixation placement in healthy aorta during EVAR.
- It highlights the potential for late-onset graft fabric defects and their severe consequences.
- Long-term surveillance protocols for EVAR patients should consider the possibility of rare graft-related complications.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
478
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
478
01:25Aortic Regurgitation III: Medical Management
581
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
581
01:28Esophageal Perforation-II: Clinical Manifestations and Management
1.0K
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
1.0K
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
585
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
585
01:28Esophageal Varices-II: Clinical Features and Management
874
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
874
01:15Aortic Regurgitation I: Introduction
1.6K
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
1.6K