Type IIIb Endoleak: The Great "Masquerader" - Risks of Liquid Agent Dislocation During Sac Embolization Techniques

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Aneurysm Repair

Background:

• Late type III endoleaks after endovascular aneurysm repair (EVAR) pose diagnostic challenges.
• Misdiagnosis of type IIIb endoleaks as type Ia endoleaks is not uncommon on non-invasive imaging.

Purpose of the Study:

• To illustrate a case of a type III endoleak misdiagnosed and treated as a type Ia endoleak.
• To report an unusual complication during liquid embolic agent embolization and its successful management.

Main Methods:

• Review of a clinical case involving endovascular aneurysm repair.
• Diagnostic imaging interpretation for endoleak characterization.
• Embolization procedure using a liquid embolic agent (Squid).

Main Results:

• A type III endoleak was initially misdiagnosed as a type Ia endoleak.
• Embolization with Squid liquid embolic agent led to intraluminal graft dislodgement of the agent.
• The complication was recognized and successfully treated.

Conclusions:

• Type IIIb endoleaks require careful consideration in patients with persistent aneurysm sac perfusion post-embolization.
• Awareness of potential complications with liquid embolic agents during EVAR procedures is crucial.