PMC6076218_01
a: Follow-up computed tomography (CT) have shown aneurysm sac disappearance 15 years after surgery. b: Significant enlargement of the aneurysm sac becomes evident 16 years after endovascular aortic aneurysm repair (EVAR). c: The last preoperative CT was undergone 5 months before re-intervention. Aneurysm sac enlarged still more. d, e: Follow-up CT at 1 month and 6 months after the re-intervention also showed no further aneurysm sac enlargement.
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Follow-up computed tomography (CT) had shown aneurysm sac shrinkage and finally sac disappearance until 15 years after surgery (Fig. 1a). However, based on follow-up CT, the aneurysm sac began to enlarge 16 years after EVAR (Fig. 1b). Enhanced CT, which was performed at our hospital 18 after EVAR, revealed an enlarged AAA and an endoleak into the aneurysm sac, but the exact source of the leak could not be identified (Fig. 1c). Follow-up CT at 6 months after the re-intervention also showed no aneurysm sac enlargement (Fig. 1e).
Preoperative abdominal ultrasound (a-c). Blood flow is detectable from the main body of the stent graft (A, B; white arrow) and from the distal edge of the right leg of the stent graft (C; white arrow). Postoperative abdominal ultrasound (a-c). Type IIIb and Ib endoleaks are no longer detectable.
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B) and flow between the distal edge of the right leg of the endograft and the right common iliac artery (Fig. 2C). Based on these findings, the endoleak from the main body of the endograft was identified as type IIIb, and the endoleak from the right leg of the endograft was identified as type Ib. Duplex ultrasound one month after re-intervention showed that the type IIIb and Ib endoleaks had disappeared (Fig. 2a-c).
Postoperative 3D-CT. An AFX endograft was placed into the Zenith main body (upper arrow), and an Endurant contralateral leg was placed into the right common iliac artery (lower arrow).
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Furthermore, an Endurant aortic extension was added just below the left renal artery to extend proximal sealing (Fig. 3).