title: Complexity of persistent type II endoleak associated with sac expansion after endovascular abdominal aortic aneurysm repair.
abstract: Type II endoleak after endovascular aortic aneurysm repair still remains the Achilles' heel of the treatment, the source of which regularly is difficult to identify and treat. We present a patient with a persistent type II endoleak associated with a continuous aneurysm sac expansion after endovascular aortic aneurysm repair for which many diagnostic modalities were used during his follow-up such as duplex scan, computed tomography angiography and magnetic resonance angiography. Attempts were undertaken to treat the source of endoleak including coil micro-embolisation of lumbar arteries and subsequent open ligation of the inferior mesenteric artery, but they failed to eliminate the endoleak. Finally, a middle sacral artery was identified as the source of the endoleak. At that time, the patient was subjected to surgery for sigmoid carcinoma, and simultaneously, a ligation of the sacral artery was undertaken which eventually eliminated the endoleak completely. This case highlights that type II endoleak may be evoked by various sources and there can be a great difficulty to identify these feeding vessels; thus, careful planning for its management is mandatory.
authors.affiliation: Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece spanos.kon@gmail.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spanos
authors.affiliation: Department of Radiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Rountas
authors.affiliation: Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Giannoukas
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Endovascular aortic aneurysm repair; coil micro-embolisation; type II endoleak