Salvage antegrade visceral revascularization and antegrade aortic stenting for type I and III endoleaks after fenestrated juxtarenal aneurysm repair

Abstract

A 73-year-old man developed type I and III endoleaks from a fractured right renal stent with downward migration of a fenestrated endograft, 6 years after endovascular repair of a juxtarenal aneurysm. Endovascular treatment attempts were unsuccessful. He underwent aortic debranching and antegrade visceral artery revascularization via a left thoracolaparotomy incision and an extraperitoneal approach to the visceral aorta. An antegrade aortic stent covered the endoleak, with technical and clinical success at 9 months. Failure of complex endografts presents particular problems, potentially not amenable to totally endovascular repair. Continued surveillance is mandated as late, asymptomatic sac expansion can occur.

The “fenestrated inside fenestrated” stent graft solution for therapy-resistant type Ia endoleak after fenestrated endovascular aortic aneurysm repair

“…Only a few experimental endovascular treatments are reported. 4,5 We present a case of a patient who had multiple unsuccessful procedures to treat a persistent type Ia endoleak after a fenestrated endovascular aneurysm repair. He was successfully treated by placing a second fenestrated endograft inside the existing one, thus, realigning the whole stent graft.…”