title: Challenging treatment of a secondary endoleak in a fenestrated endograft.
abstract: OBJECTIVE
  To describe the novel use of an Amplatzer occluder device to seal a secondary endoleak arising at a scallop in a fenestrated stent-graft.
  
  
  METHODS
  A 67-year-old man with comorbidities precluding standard endovascular repair of a pararenal aortic aneurysm was treated with a fenestrated endoprosthesis containing one fenestration for the left renal artery and one scallop for the celiac trunk; the right renal and superior mesenteric arteries were occluded at presentation. Interval imaging at 2 years showed a proximal type I endoleak at the celiac trunk scallop associated with expansion of the aneurysm sac. Attempted repair with an aortic extension cuff and a "chimney" stent was unsuccessful. An Amplatzer Patent Foramen Ovale occluder device was deployed across the endoleak to provide aneurysm sac exclusion, which has been maintained at 6-month follow-up.
  
  
  CONCLUSIONS
  Treatment of a secondary type I endoleak after implantation of a fenestrated endoprosthesis is challenging. The novel use of an Amplatzer occluder in this setting may be applicable to other situations in which an endovascular solution is desirable for complications of complex endovascular aneurysm repair.
authors.affiliation: Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, France.
authors.forename: Guilherme
authors.initials: G
authors.lastname: d'Utra
authors.forename: Noel
authors.initials: N
authors.lastname: O'Brien
authors.forename: Filippo
authors.initials: F
authors.lastname: Maioli
authors.forename: Céline
authors.initials: C
authors.lastname: Perot
authors.forename: Aurelia
authors.initials: A
authors.lastname: Bianchini
authors.forename: Blandine
authors.initials: B
authors.lastname: Maurel
authors.forename: Matthieu
authors.initials: M
authors.lastname: Guillou
authors.forename: Piervito
authors.initials: P
authors.lastname: D'Elia
authors.forename: Richard
authors.initials: R
authors.lastname: Azzaoui
authors.forename: Stéphan
authors.initials: S
authors.lastname: Haulon
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D055989:Septal Occluder Device; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome