Treatment of a Delayed Type IIIb Endoleak 20 Years Post EVAR With Inverted Contralateral Limb Custom-Made Device: A Case Report

• Published in: Journal of endovascular therapy Vol. 30; no. 2; p. 307
• Main Authors: Linn, Yun Le, Tay, Kiang Hiong, Ng, Nick Zhi Peng, Lee, Shaun Qingwei, Tang, Tjun Yip, Chong, Tze Tec
• Format: Journal Article
• Language: English
• Published: United States 01.04.2023
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Endoleak - diagnostic imaging; Endoleak - etiology; Endoleak - surgery; Endovascular Procedures - adverse effects; Humans; Male; Retrospective Studies; Stents - adverse effects; Treatment Outcome; endoleak; AAA; inverted contralateral limb; EVAR; CMD
• ISSN: 1545-1550
• DOI: 10.1177/15266028221079762

Type III endoleak can be difficult to distinguish from Type I endoleak. Depending on the stent graft anatomy, the use of standard bifurcated endografts may not be technically feasible, and patients may have to be subject to an aorto-uni-iliac repair with femoral-femoral bypass or open surgery. We report a case of an 86-year-old male who had a Type IIIb endoleak 20 years post EVAR which was characterized on angiography to be from a hole close to the bifurcation limb origin. The initial Talent (Medtronic, Santa Rosa, California) device had a 50 mm main body common trunk, which was not amenable to treatment with standard devices. He was successfully treated with a custom-made device with an inverted contralateral limb. Our case highlights the need for lifelong surveillance post EVAR as endoleak may present decades post initial EVAR. It also demonstrates that many Type III endoleak which were otherwise deemed unsuitable for treatment with standard devices may potentially be treatable with custom-made device (CMD). This solution preserves a percutaneous option in a now older person which avoids surgical bypass. Further studies are required to establish the durability of this treatment and survey for recurrence.