PMC10023992_01
Follow up computed tomography (CT) scans showing progressive aneurysm growth of the right common iliac artery: 2017 - 114 x 120 mm (A); 2020 - 133 x 155 mm (B). And CT scan performed at the emergency department, revealing aneurysm rupture: 2022 - 134 x 187 (C).
gr1.jpg
PMC10023992_01_gr1.jpg
fig1
II endoleak through lumbar and pelvic collaterals. Coil embolisation of the right internal iliac artery and collaterals and CT guided thrombin injection of the aneurysmatic sac was attempted (2010), but nothing had managed to successfully treat the aneurysm. In 2011, the patient refused any further treatments either by open surgery or endovascular procedures; he was kept on annual follow up at the outpatient clinic, showing progressive growth of the aneurysm (Figure 1A and B).
Giant common iliac aneurysm was identified after midline laparotomy (A). This was followed by emptying and removing thrombus from the aneurysmatic sac (B). A small tear at the right iliac limb extension (circle) of the endograft was identified. The zoomed image at the upper right corner marks the location of the tear with an arrow (C).
gr2.jpg
PMC10023992_01_gr2.jpg
fig2
No signs of type II endoleak were found, yet a fissure like tear in the fabric of the endograft at the right iliac limb was identified as the cause of the chronic endoleak (type IIIb) (Figure 2).
Curved haemostatic forceps was used to reference the tear, then a stent graft was released to reline the lesion (A and B).
gr3.jpg
PMC10023992_01_gr3.jpg
fig3
A curved haemostatic forceps was used as a reference to mark the level of the tear, then a retrograde right femoral access was obtained and an Endurant II Limb (16 x 16 x 82 mm) (Medtronic, Minneapolis, MN, USA) stent graft was used for relining the lesion, successfully managing to treat the type IIIb endoleak (Figure 3).