title: External aortic wrap for repair of type 1 endoleak.
abstract: BACKGROUND
  Type 1 endoleak is a rare complication after endovascular abdominal aortic aneurysm repair (EVAR) with a reported frequency up to 2.88%. It is a major risk factor for aneurysmal enlargement and rupture.
  
  
  METHODS
  We present a case of a 68 year old gentleman who was found to have a proximal type 1 endoleak with loss of graft wall apposition on routine surveillance imaging post-EVAR. An initial attempt at endovascular repair was unsuccessful. Given the patient's multiple medical co-morbidities, which precluded the possibility of conventional graft explantation and open repair, we performed a novel surgical technique which did not require aortic cross-clamping. A double-layered Dacron wrap was secured around the infra-renal aorta with Prolene sutures, effectively hoisting the posterior bulge to allow wall to graft apposition and excluding the endoleak. Post-operative CT angiogram showed resolution of the endoleak and a stable sac size.
  
  
  CONCLUSIONS
  Several anatomical factors need to be considered when this technique is proposed including aortic neck angulation, position of lumbar arteries and peri-aortic venous anatomy. While an external wrap technique has been investigated sporadically for vascular aneurysms, to our knowledge there is only one similar case in the literature.
  
  
  CONCLUSIONS
  Provided certain anatomical features are present, an external aortic wrap is a useful and successful option to manage type 1 endoleak in high-risk patients who are unsuitable for aortic clamping.
authors.affiliation: Department of Vascular Surgery, Western Hospital, Gordon Street, Footscray, VIC 3011, Australia. Electronic address: anastasiaedean@gmail.com.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dean
authors.affiliation: Department of Vascular Surgery, Western Hospital, Gordon Street, Footscray, VIC 3011, Australia.
authors.forename: Swee Leong
authors.initials: SL
authors.lastname: Yap
authors.affiliation: Department of Vascular Surgery, Western Hospital, Gordon Street, Footscray, VIC 3011, Australia.
authors.forename: Venu
authors.initials: V
authors.lastname: Bhamidipaty
authors.affiliation: Department of Vascular Surgery, Western Hospital, Gordon Street, Footscray, VIC 3011, Australia.
authors.forename: Franklin
authors.initials: F
authors.lastname: Pond
keywords: AAA; Dacron graft; EVAR; Endoleak