Laparoscopic Clipping of the Inferior Mesenteric Artery for Persistent Endoleak After Endovascular Stent-Graft Treatment of Abdominal Aortic Aneurysm

Abstract

As an alternative to surgical resection with prosthesis implantation in high-risk patients, infrarenal abdominal aortic aneurysms (AAAs) could be excluded less invasively by endovascular stent-grafts. Persistent perigraft leaks remain a significant complication because of potential aneurysmal growth and rupture. The authors describe a 49-yearold high-risk patient who was treated with Talent endograft for increasing AAA. A residual retrograde filling of the aneurysm sac, caused by patent inferior mesenteric and lumbar arteries, was detected during follow-up. Four months after primary endovascular treatment they successfully carried out laparoscopic clipping of the inferior mesenteric artery (IMA) while maintaining the sigmoidal and superior rectal arteries. The postoperative computed tomography angiography 2 days later showed complete sealing of the aneurysm sac without a change of size of the AAA.

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