Type II endoleak: transperitoneal sacotomy and ligation of side branch endoleaks responsible for aneurysm sac expansion.
OBJECTIVE
To demonstrate aneurysm sac expansion in the face of a type II endoleak and its treatment with open ligation of multiple side branch endoleaks.


METHODS
An 81-year-old patient had undergone elective endovascular repair of a 6.3-cm infrarenal abdominal aortic aneurysm in September 1999. Routine spiral computed tomographic angiography at 10 months disclosed a type II endoleak; the aneurysm sac diameter had grown to 7.4 cm. Selective angiography revealed multiple lumbar endoleaks and a patent inferior mesenteric artery. Laparotomy and sacotomy was performed, confirming the presence of pulsatile type II endoleaks, which were ligated successfully. The patient made a full postoperative recovery.


CONCLUSIONS
Type II endoleaks may cause aneurysm expansion. Open repair of multiple type II endoleaks is feasible and may be useful where endovascular or laparoscopic techniques are at high risk of procedural failure, such as multiple endoleak channels.
Hinchliffe
Robert J
RJ
Department of Vascular and Endovascular Surgery, University Hospital, Nottingham, England, UK. robhinchliffe@hotmail.com
Singh-Ranger
Ravinder
R
Whitaker
Simon C
SC
Hopkinson
Brian R
BR
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D008026:Ligation; D008297:Male; D011475:Prosthesis Failure