title: Management of a large intraoperative type IIIb endoleak in a bifurcated endograft-a case report.
abstract: The purpose of this paper is to describe the intraoperative management of a type IIIb endoleak after deployment of a bifurcated endograft in a patient with narrow iliac access vessels. A 62-year-old man underwent elective endovascular repair (EVAR) of a 53 mm abdominal aortic aneurysm. After device deployment, a large IIIb endoleak, arising from the main body of the device, was visualized. Narrow iliac vessels precluded deployment of a second bifurcated graft, and the endoleak was successfully excluded with an aortomonoiliac device, followed by contralateral iliac occlusion and subsequent creation of a femorofemoral bypass. At 1-year follow-up, the aneurysm remains excluded and is decreasing in size. Type III endoleaks are a known complication of EVAR, requiring immediate treatment through their association with aneurysm enlargement and rupture. If an additional bifurcated graft cannot be used, aortomonoiliac conversion represents a feasible endovascular alternative treatment for type III endoleaks, other than conversion to open surgical repair. Therefore, aortomonoiliac converters with appropriate occluder devices should be readily available during deployment of bifurcated devices.
authors.affiliation: Section of Vascular Surgery, Mayo Clinic Jacksonville, FL 32224, USA.
authors.forename: Matthias
authors.initials: M
authors.lastname: Biebl
authors.forename: Albert G
authors.initials: AG
authors.lastname: Hakaim
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Oldenburg
authors.forename: Josef
authors.initials: J
authors.lastname: Klocker
authors.forename: J Mark
authors.initials: JM
authors.lastname: McKinney
authors.forename: Ricardo
authors.initials: R
authors.lastname: Paz-Fumagalli
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D021721:Balloon Occlusion / Q000295:instrumentation; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*