Total realignment of multibranch stent graft using redo branch-in-branch endovascular repair for occult endoleak with rapid aneurysm sac expansion

Aleem K. Mirza, Emanuel R. Tenorio, Thanila A. Macedo, Jussi M. Kärkkäinen, Swati Chaparala, Gustavo S. Oderich

Research output: Contribution to journalArticle

Abstract

Occult endoleaks can pose a diagnostic and treatment challenge. These endoleaks are not effectively identified by multiphase computed tomography angiography, magnetic resonance angiography, or contrast-enhanced ultrasound. Possible causes are small fabric tears and slow-flow, dynamic, or positional endoleaks. We describe a patient with rapid aneurysm sac expansion and disseminated intravascular coagulopathy 46 months after four-vessel branched physician-modified endograft repair of a ruptured extent III thoracoabdominal aneurysm. Imaging failed to demonstrate an endoleak but identified fresh blood products within the sac. The patient underwent total realignment using branch-in-branch repair with a physician-modified endograft. Repeated imaging 25 days postoperatively revealed decrease in aneurysm diameter by 10 mm.

Original languageEnglish (US)
Pages (from-to)392-396
Number of pages5
JournalJournal of Vascular Surgery Cases and Innovative Techniques
Volume6
Issue number3
DOIs
StatePublished - Sep 2020

Keywords

  • Endotension
  • Fenestrated and branched endovascular aortic repair
  • Occult endoleak
  • Physician-modified endovascular graft
  • Type V endoleak

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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