PMC5033069_01
Intra-operative completion angiogram during initial EVAR demonstrating no Type 1 or Type III endoleak.
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Type 1 endoleak, with late filling of the sac secondary to Type II endoleak from the lumbar arteries (Figure 1). There were no complications peri-operatively, and the Type II endoleak ceased on the 1-month follow-up computerized tomography (CT).
Contrast-enhanced CT scan at 2-year follow-up after initial EVAR demonstrating sac regression and no Type III endoleak.
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CT scan at 1 month, 6 months and annually thereafter to assess for graft-related complications. CT scan at 2-year follow-up demonstrated sac regression with no endoleaks (Figure 2).
Contrast-enhanced CT scan demonstrating Type IIIb endoleak and sac expansion 7 years after initial EVAR.
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Based on initial surveillance ultrasound and subsequent CT scan, the source of endoleak was challenging to deduce; a Type 1a leak was initially suspected though stent migration or neck expansion was excluded (Figure 3).
Pre-operative angiogram demonstrating Type IIIb endoleak from proximal left graft limb.
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Angiogram was then performed revealing Type IIIb endoleak arising from a tear in the distal main body or proximal left graft limb (Figure 4).
Post-operative CT scan demonstrating successful exclusion of Type IIIb endoleak with aortouniiliac Endurant II graft. No endoleak is demonstrated and aneurysm is stable.
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Talent occluder (20 mm) was placed in the right common iliac artery to prevent retrograde filling (Figure 5). The patient recovered well and was discharged 2 days post-operatively.