title: Type IIIb endoleak is an important cause of failure following endovascular aneurysm repair.
abstract: OBJECTIVE
  To present confirmed cases of type IIIb endoleak in second and third-generation stent-grafts used for endovascular aneurysm repair (EVAR).
  
  
  METHODS
  Four patients developed type IIIb endoleak caused by fabric tears between 4 and 13 years following their initial EVAR. Three patients presented with rupture and one with aneurysm expansion of unknown cause. In each case, the type IIIb endoleak was confirmed at open surgery after imaging proved non-diagnostic. Only one patient survived. Had the cause for the expansion or ruptures been found prior to open reintervention, relining of the stent-graft may have been possible.
  
  
  CONCLUSIONS
  Type IIIb endoleak remains difficult to diagnose. Avoidance of the high mortality associated with open secondary intervention requires a high degree of suspicion and it should be considered in any post-EVAR aneurysm expansion without an obvious cause.
authors.affiliation: 1 Liverpool Vascular and Endovascular Service, Royal Liverpool Hospital, Liverpool, UK.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Jones
authors.forename: S Rao
authors.initials: SR
authors.lastname: Vallabhaneni
authors.forename: Richard G
authors.initials: RG
authors.lastname: McWilliams
authors.forename: Jagjeeth
authors.initials: J
authors.lastname: Naik
authors.forename: Tom
authors.initials: T
authors.lastname: Nicholas
authors.forename: Robert K
authors.initials: RK
authors.lastname: Fisher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D017211:Treatment Failure
keywords: aneurysm expansion; diagnosis; endoleak; endovascular aneurysm repair; failure; rupture