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Abstract

Purpose

To present confirmed cases of type IIIb endoleak in second and third-generation stent-grafts used for endovascular aneurysm repair (EVAR).

Case Reports

Four patients developed type IIIb endoleak caused by fabric tears between 4 and 13 years following their initial EVAR. Three patients presented with rupture and one with aneurysm expansion of unknown cause. In each case, the type IIIb endoleak was confirmed at open surgery after imaging proved non-diagnostic. Only one patient survived. Had the cause for the expansion or ruptures been found prior to open reintervention, relining of the stent-graft may have been possible.

Conclusion

Type IIIb endoleak remains difficult to diagnose. Avoidance of the high mortality associated with open secondary intervention requires a high degree of suspicion and it should be considered in any post-EVAR aneurysm expansion without an obvious cause.

Keywords

endovascular aneurysm repair failure endoleak aneurysm expansion rupture diagnosis

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References

Brown

Powell

Thompson

. The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy. Health Technol Assess. 2012;16:1–218.

Stather

Sidloff

Dattani

. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg. 2013;100:863–872.

Cao

De Rango

Parlani

. Durability of abdominal aortic endograft with the Talent Unidoc stent graft in common practice: core lab reanalysis from the TAURIS multicenter study. J Vasc Surg. 2009;49:859–865.

Pitton

Scheschkowski

Ring

. Ten-year follow-up of endovascular aneurysm treatment with Talent stent-grafts. Cardiovasc Intervent Radiol. 2009;32:906–917.

Major

Guidoin

Soulez

. Implant degradation and poor healing after endovascular repair of abdominal aortic aneurysms: an analysis of explanted stent-grafts. J Endovasc Ther. 2006;13:457–467.

Seriki

Ashleigh

Butterfield

. Midterm follow-up of a single-center experience of endovascular repair of abdominal aortic aneurysms with use of the Talent stent-graft. J Vasc Interv Radiol. 2006;17:973–977.

Bove

Long

Shanley

. Trans-renal fixation of endovascular stent-grafts for infrarenal aortic aneurysm repair: mid-term results. J Vasc Surg. 2003;37:938–942.

Bucci

Fiengo

Valerio

. Late type IIIb endoleak after endovascular aneurysm repair: case report and review of the literature. G Chir. 2011;32:329–333.

Reijnen

Minion

Lardenoye

. Treatment of a type IIIb endoleak in a Talent endograft using telescoping cuffs and two parallel upside-down excluder contralateral legs. J Vasc Surg. 2012;56:538–541.

10.

Mertens

Houthoofd

Daenens

. Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft. J Vasc Surg. 2011;54:48–57.e2.

11.

Juszkat

Staniszewski

Zarzecka

. Diagnosis of type III endoleak and endovascular treatment with aortouniiliac stent-graft. J Vasc Interv Radiol. 2009;20:125–129.

12.

Wanhainen

Nyman

Eriksson

. First report of a late type III endoleak from fabric tears of a Zenith stent graft. J Vasc Surg. 2008;48:723–726.

13.

Wyss

Brown

Powell

. Rate and predictability of graft rupture after endovascular and open abdominal aortic aneurysm repair: data from the EVAR Trials. Ann Surg. 2010;252:805–812.

14.

Schlösser

Gusberg

Dardik

. Aneurysm rupture after EVAR: can the ultimate failure be predicted? Eur J Vasc Endovasc Surg. 2008;37:15–22.

15.

Zarins

Arko

Crabtree

. Explant analysis of AneuRx stent grafts: relationship between structural findings and clinical outcome. J Vasc Surg. 2004;40:1–11.

16.

Chuter

. Durability of endovascular infrarenal aneurysm repair: when does late failure occur and why? Semin Vasc Surg. 2009;22:102–210.

17.

Jacobs

Won

Gravereaux

. Mechanical failure of prosthetic human implants: a 10-year experience with aortic stent graft devices. J Vasc Surg. 2003;37:16–26.

18.

Brinster

Fairman

Woo

. Late open conversion and explantation of abdominal aortic stent grafts. J Vasc Surg. 2011;54:42–46.

19.

Kelso

Lyden

Butler

. Late conversion of aortic stent grafts. J Vasc Surg. 2009;49:589–595.

Type IIIb Endoleak Is an Important Cause of Failure Following Endovascular Aneurysm Repair