title: Endovascular rescue of a thoracoabdominal fenestrated endograft presenting with combined type 1 and type 3 endoleaks from aortic graft migration and visceral stent separation.
abstract: BACKGROUND
  To describe successful endovascular rescue of a prior fenestrated endograft repair of a thoracoabdominal aneurysm that presented with combined type I and type III endoleaks due to aortic stent migration and subsequent visceral stent dislodgement.
  
  
  METHODS
  A 67 year old male with significant cardiac dysfunction and chronic renal insufficiency underwent fenestrated endograft repair of a 7 cm type IV thoracoabdominal aneurysm with 4 fenestrations in 2008. He presented with acute onset abdominal pain. CT scan revealed type I and III endoleaks with aneurysm enlargement to 10 cm. Angiography revealed the superior mesenteric and renal artery stents within their target vessels, but separation from their respective fenestrations in the aortic graft with significant gaps (>15 mm) and resultant type 3 endoleaks. The celiac artery stent was fractured; part of it remained within the celiac artery and part within the celiac fenestration and a 30 mm craniocaudal gap between the two pieces. All 4 visceral stents were patent with intact distal flow. A large proximal type 1 endoleak was also seen. All fenestrations were successfully catheterized via percutaneous approach and gaps were successfully bridged with covered stents eliminating the type III endoleaks. A thoracic endograft was placed proximally to repair the type I endoleak.
  
  
  RESULTS
  Completion angiography demonstrated successful resolution of the type I and type III endoleaks with flow through all 4 branches and tertiary vessels.
  
  
  CONCLUSIONS
  Endovascular rescue of prior branched endografts is a feasible solution in patients at prohibitive risk for open surgery.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322, USA.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Patel
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsilimparis
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Ricotta
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome