PurposeType I endoleak is known to be associated with sac enlargement and occasional rupture, therefore, the treatment of type I endoleak is recommended at the time of diagnosis. The aim of this study was to identify the significance of early type I endoleak found on completion angiography.MethodsBetween January 2000 and December 2012, a total of 86 patients underwent endovascular abdominal aortic aneurysm repair (EVAR) and 10 patients (11.6%) were diagnosed with type Ia endoleak on completion angiography. Clinical and radiologic data were reviewed retrospectively.ResultsOf the 10 patients, two underwent EVAR with custom-made stent-grafts in the initial stage and both of them needed immediate treatment: one case involved open repair while the other involved insertion of an additional stent-graft. In 8 patients, the amount of leakage decreased after repeated balloon molding. They were managed conservatively and followed up with computed tomography angiography within 2 weeks after EVAR. In 7 of the 8 cases, type Ia endoleaks disappeared. In one patient with a persistent endoleak and a folded posterior wall of the stent-graft, coil embolization was performed 1 week after EVAR. With a median follow-up of 12 months (range, 1-61 months), no patients showed recurrence of type I endoleak or sac expansion.ConclusionType I endoleaks diagnosed on completion angiography sealed spontaneously in 7 of 10 patients (70.0%). In cases of decreased amounts of leakage after balloon molding, simple observation may be an alternative to repetitive procedures. The long-term follow-up of patients with self-sealed type I endoleaks is mandatory.

Femoral-anterior tibial artery bypasses with autogenous grafts are difficult to perform when sufficiently long saphenous veins are not available. We performed 12 bypasses on patients with Buerger disease during a 20-year period using a new intermuscular tunneling technique. The graft is passed from the thigh between the muscle compartments without penetrating the muscle fibers, providing an anatomically superior and shorter path. The primary patency rates were 75% at 5 years and 65% at 10 years. We believe that our tunneling technique is safe and durable and might be a viable alternative for proximal femoral-anterior tibial artery bypass in selected patients.