PMC7226921_01
Computed tomography angiography at patient presentation demonstrating contrast extravasation (white arrow) in the right limb of the endovascular aneurysm repair device, representing concern for new type IIIb endoleak.
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CTA demonstrated a stable 11 cm aneurysm with contrast extravasation and possible concern for a new endoleak that was presumed to be a type III (Fig. 1).
Turbulent flow (63 cm/sec) in the aneurysm sac suspicious of endoleak (A). Type III endoleak with flow jet in right limb of endovascular aneurysm repair device (arrow, B). Colour flow demonstrates positive velocity through endoleak (C-E). Peak velocity of flow jet from right limb is 450 cm/sec (F).
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CDUS was performed which confirmed an obvious type IIIb endoleak (Fig. 2). CDUS metrics described the nature of the endoleak: the velocity of flow in the aneurysm sac was 63 cm/sec, and the source of the endoleak was a flow jet from the body of the right limb of the EVAR device, with a systolic velocity peak of 450 cm/sec.
Endoleak extravasation from right limb of endovascular aneurysm repair device confirmed on angiogram (arrow, A). No endoleak extravasation from right limb after stent graft placement (B).
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An aortogram confirmed a type IIIb endoleak in the right limb, with evidence of device disruption (Fig. 3A, the red arrow pointing to contrast smear demonstrating endoleak). Owing to significant tortuosity, a Viabahn VBX graft (WL Gore and Associates, Flagstaff, AZ) was placed over the leak site, and a subsequent aortogram demonstrated endoleak resolution (Fig. 3B).
Absence of turbulent flow around body of stent graft confirms treatment of endoleak (A). Unidirectional laminar flow within the right limb borders with no evidence of flow jet wave outside the limb confirms successful treatment of type III endoleak (B, C).
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A final CDUS confirmed no evidence of flow in the revised aneurysm sac (Fig. 4).