PMC5941777_01
Preoperative CT scan. Contrast media had to be avoided due to severe renal failure. The Talent stent-graft was migrated and the proximal sealing was lost ((a)-(c)) leading to potential type I endoleak, sac enlargement, and rupture. A leaking 9 cm AAA with a huge retroperitoneal hematoma was depicted ((d) and (e)). Distal iliac sealing was sufficient (f).
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fig1
A leaking 9 cm AAA with a huge retroperitoneal hematoma was depicted (Figure 1). The Talent stent-graft was migrated (Figure 1) and the proximal sealing was lost, leading to potential type I endoleak, sac enlargement, and rupture.
Initial intraoperative angiography. The Talent suprarenal crown was found to be damaged ((a), white arrow), the endograft was migrated 2 cm distally to the left renal artery ((b), red arrow and red bracket), and the proximal sealing was lost and a type Ia endoleak was shown ((c) black arrow). At the moment the second endoleak ((c), red star) pool was advocated as a continuation from the Ia endoleak.
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fig2
The Talent was migrated 2 cm distally to the left (lower) renal artery, the proximal sealing was lost, and a huge type Ia endoleak was shown (Figure 2).
A 28 x 60 Ankura aortic extender was deployed to bridge the proximal remaining aortic neck with the migrated Talent body.
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fig3
Based upon the CT measurements and the intraoperative data, a 28 mm in diameter x 60 mm in length Ankura (LifeTech, Inc., China) aortic extender with 15 mm bare stent was deployed (Figure 3) to bridge the proximal aortic neck (estimated 24 mm in diameter x 15 mm in length) with the migrated Talent body (26 mm in diameter x 50 mm in length tubular segment).
Contrast media continued to be visible outside the Talent endograft after the Ankura cuff deployment, restricted at the level of its bifurcation ((a), red star). Balloon inflation did not seal the endoleak; on the contrary, a fabric tear becomes apparent near the stent-graft bifurcation feeding the endoleak ((b), red arrow). A guide wire was passed through the fabric opening for verification ((c), black arrow).
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fig4
To our surprise, contrast media continued to be visible in a different fashion from the initial angiography outside the Talent endograft restricted at the level of its bifurcation (Figure 4). Talent body, a fabric tear became apparent near the stent-graft bifurcation (Figure 4) feeding the endoleak. The balloon was removed and a guide wire was meticulously passed through the fabric opening to verify the fabric tear and the type IIIb endoleak (Figure 4).
(a) Two Ankura limbs, 16-16 x 100, were simultaneously deployed as parallel kissing endografts. The proximal 6 cm of the parallel endografts was positioned above the Talent bifurcation within the Ankura cuff and the distal 4 cm inside each Talent limb. (b) Completion of angiogram verified endoleak resolution, renal and iliac artery patency, and proper endograft deployment.
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fig5
Two Ankura limbs, 16-16 x 100, were inserted and simultaneously deployed as parallel kissing endografts. The proximal 6 cm of the parallel endografts was positioned above the Talent bifurcation within the Ankura cuff and the distal 4 cm inside each Talent limb below the Talent bifurcation (Figure 5) to ensure adequate sealing of the fabric tear.