title: Successful repair of a type 2 endoleak with coiling of inferior mesenteric artery.
abstract: BACKGROUND
  One of the most common complications of endovascular aneurysm repair (EVAR) is type 2 endoleak. We describe a patient who presented with a recurrent endoleak despite initial intervention and was successfully treated with coil embolization of the inferior mesenteric artery (IMA).
  
  
  METHODS
  A 63-year-old Caucasian male was found to have a 7.5 cm abdominal aortic aneurysm (AAA) during a routine ultrasound of the kidneys. The patient successfully underwent EVAR with exclusion of the aneurysm sac. A computed tomographic (CT) scan was performed 30 days after the procedure, and showed presence of a large type 1a endoleak with slight enlargement of the sac. The endoleak was successfully repaired with 2 extension cuffs which resulted in resolution of the endoleak. A few months later, another CT scan was performed that showed a type 2 endoleak without enlargement of the sac; however, there was no reduction in the size of the sac. Multiplanar reconstruction was used and a small branch connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA) through the marginal artery was found. A selective angiogram of the SMA was performed that showed filling of the aneurysm sac. A microcatheter was advanced through the SMA and marginal artery into the IMA. The IMA was occluded with coil embolization, resulting in resolution of the endoleak.
  
  
  CONCLUSIONS
  Our case describes a patient who initially underwent treatment for type 1a endoleak and subsequently developed type 2 endoleak that was successfully treated with coil embolization of the IMA.
authors.affiliation: Department of Cardiology, Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA. eras_27@yahoo.com
authors.forename: Haroon L
authors.initials: HL
authors.lastname: Chughtai
authors.forename: Muhammad
authors.initials: M
authors.lastname: Janjua
authors.forename: Kirit
authors.initials: K
authors.lastname: Patel
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging; D008875:Middle Aged; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome