Semi-inner branch relining for late AFX type Ia/IIIa endoleak

Late failure of early-generation AFX endografts (Endologix Inc) remains a relevant challenge, sometimes presenting as combined type IA/IIIA endoleak many years after apparently successful endovascular aneurysm repair. We report an 85-year-old man who developed rapid sac enlargement 13 years after AFX-Strata implantation (Endologix Inc) due to modular disconnection and proximal cuff migration. He was treated with relining using a custom-made semi-inner branch endograft, with adjunctive proximal thoracic extension to seal a residual endoleak. Completion angiography and follow-up computed tomography angiography confirmed complete exclusion and branch patency, with uneventful recovery. This case highlights the need for lifelong surveillance after AFX implantation and supports semi-inner branch relining for high-risk patients.