Complex endoleak treatment after failed endovascular aortic repair

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Endovascular Aneurysm Repair (EVAR) is increasingly popular for abdominal aortic aneurysms (AAAs).
• EVAR offers reduced mortality and morbidity compared to open repair in select patients.
• Endoleaks (ELs) are a significant complication of EVAR, necessitating prompt treatment to prevent AAA sac rupture.

Purpose of the Study:

• To describe the urgent endovascular management of a high-risk type IA endoleak.
• To present a case utilizing the chimney technique for endoleak management.
• To highlight an alternative treatment for type II endoleaks.

Main Methods:

• Urgent endovascular treatment of a type IA endoleak in a polymorbid patient 7 years post-EVAR.
• Parallel implantation of proximal stent graft (SG) extension and renal SG into the right renal artery (chimney technique).
• Transabdominal AAA sac puncture and thrombin embolization for a subsequent type II endoleak.

Main Results:

• Successful urgent endovascular repair of a high-risk type IA endoleak.
• Effective management of a type II collateral endoleak via embolization.
• Demonstration of the chimney technique's utility in an emergency setting.

Conclusions:

• Endoleaks (ELs) can necessitate urgent intervention, often requiring specialized stent grafts (SGs).
• The chimney technique enables the use of readily available SGs for endoleak management.
• This approach is crucial in cases of impending abdominal aortic aneurysm (AAA) rupture.