PMC4927212_01
Preoperation CT showed a 90-mm RAAA communicating with 12-mm aorto-caval fistula.
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ACF which was 12 mm in diameter. Angulated aneurysm and tortuous aorto-iliac access were also shown (Figure 1).
The angiography during the procedure: (a) intraoperative angiography showed continuing type Ia endoleak and Ib endoleak at the left common iliac artery and leakage into the venal cava; (b) a TRI-LOBE balloon was expanding to seal the Excluder Cuff stent-graft to the aneurysm neck; (c) expanding at the junction and dilating overlapping zone between Excluder iliac leg and Zenith iliac leg.
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After standard EVAR, however, persistent type Ia endoleak and Ib endoleak at the left common iliac artery (CIA) were confirmed via intraoperative angiography (Figure 2(a)). Gore Excluder Cuff (W.L. Gore & Associate, Flagstaff, AZ, USA) (Figure 2(b)) and a combination of Gore Excluder iliac leg with Zenith iliac leg at the left CIA (Figure 2(c)).
CT angiography 12 months after EVAR procedure showing favourable remodelling of the aorta, no type II endoleak and no recurrence of the A-V, arterio-venous communication.
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Follow-up CTA at 12 months demonstrated complete resolution of ACF without type II endoleak (Figure 3).