Endovascular Aneurysm Repair for a Sac Enlargement Caused by Type IIIb Endoleak Diagnosed Using Four-Dimensional...

We describe a case in which 4-dimensional computed tomography (4D-CT) was used to detect a type IIIb endoleak after endovascular aneurysm repair (EVAR).

The patient was a 75-year-old man who underwent EVAR for abdominal aortic aneurysm at our institute 13 years before presentation. The patient had been aortic event-free for 10 years postoperation. However, the sac gradually enlarged after 10 years and reached 55 mm in diameter. Traditional contrast-enhanced CT showed an endoleak but could not be used in type determination (type II or III). Four-dimensional-CT enabled us to make a definitive diagnosis of a type IIIb endoleak; therefore, relining EVAR was performed as a reintervention. Postoperative contrast-enhanced computed tomography confirmed disappearance of the endoleak.

Type IIIb endoleaks following EVAR are often difficult to diagnose using traditional modalities. Thus, 4D-CT may be useful in identifying endoleak types.Clinical ImpactThis case report highlights the effectiveness of four-dimensional computed tomography (4D-CT) in diagnosing type IIIb endoleaks after endovascular aneurysm repair (EVAR). Traditional imaging methods often fail to accurately identify this type of endoleak, which can lead to aneurysm rupture if untreated. The use of 4D-CT allowed for a definitive diagnosis and timely reintervention, thus improving patient outcomes. Incorporating 4D-CT into post-EVAR surveillance protocols may enhance the detection and management of type IIIb endoleaks, potentially reducing the risk of complications and improving long-term patient prognosis.