Back-table fenestrated endograft limb inversion for type Ia endoleak repair

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Type Ia endoleaks are a complication of endovascular aortic aneurysm repair (EVAR).
• Proximity to renal arteries complicates standard endoleak repair.
• Previous repair strategies include open surgery or complex fenestrations.

Purpose of the Study:

• To present a case of type Ia endoleak successfully treated with a modified endograft.
• To demonstrate a novel technique for endoleak repair in challenging anatomy.

Main Methods:

• A type Ia endoleak was identified in an aortic endograft near the renal arteries.
• A back-table physician-modified endograft was created with contralateral limb inversion.
• This allowed deployment of a fenestrated cuff and bifurcated main body over the existing flow divider.

Main Results:

• The modified endograft successfully excluded the type Ia endoleak.
• This technique avoided the need for open aneurysm repair, physician-made fenestrations, or aorto-uni-iliac repair with bypass.
• The procedure was technically straightforward and reproducible.

Conclusions:

• Back-table physician-modified endograft contralateral limb inversion is an effective technique for type Ia endoleaks.
• This approach offers a viable alternative to more invasive repair methods.
• The technique is easy to perform and reproducible in clinical practice.