PMC5990265_01
Reconstructed three-dimensional image shows a large, type Ia endoleak (arrow) and enlargement of the aneurysm to 120 mm in diameter, in the third year after the first repair.
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The patient had no further follow up until the third year after the first repair, and then, in the third and fourth years after the first repair, had been treated twice for stent migration and type Ia endoleak with placement of a stent graft over the non-adhesive portion of the stent graft ( Figure 1 ). 
Post-procedure 62-month CT-scan depicting a large, type III endoleak (graft disconnection arrowed) and enlargement of the aneurysm to 133 mm in diameter.
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Expansion of the aneurysm sac (to 133 mm), type III endoleak (disconnection of main body from the bifurcated aortoiliac endovascular graft), and ruptured aneurysm sac were now evident on CT scan ( Figure 2 ).
The aneurysm sac was opened under aortic cross-clamping. Disconnection of graft components is clearly visible (arrow).
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The aneurysm sac was opened by longitudinal aortotomy, a large quantity of mural thrombus was removed, and the disconnection of the main graft body from the bifurcated aortoiliac endovascular graft was observed ( Figure 3 ).