title: Use of the Off-the-Shelf t-Branch Device to Treat an Acute Type Ia Endoleak in a Symptomatic Juxtarenal Abdominal Aortic Aneurysm.
abstract: OBJECTIVE
  To report the use of the off-the-shelf Zenith t-Branch Thoracoabdominal Endovascular Graft for the treatment of a symptomatic acute type Ia endoleak subsequent to previous infrarenal bifurcated endovascular aneurysm repair.
  
  
  METHODS
  A 72-year-old man presented 4 years after implantation of an Anaconda stent-graft with sac expansion and type II endoleak, which was treated over the next 18 months with repeated coil and glue embolization of the leak and sac. Six months after the last attempt, imaging disclosed a new type Ia endoleak. Sac enlargement became symptomatic, and emergent treatment was performed using the off-the-shelf Zenith b-Branch device. The 4 visceral arteries were bridged with Fluency stent-grafts. The Anaconda stent-graft precluded the use of a standard Zenith universal distal body bifurcated device below the t-Branch graft, so a reversed tapered 16×20×82-mm iliac limb was placed to bridge the t-Branch to the larger Anaconda limb; the smaller 12-mm contralateral Anaconda limb was occluded. The procedure was concluded with a femorofemoral bypass. At 10 months after the procedure, the patient is well; the sac diameter has decreased, and there is no endoleak on imaging.
  
  
  CONCLUSIONS
  The multibranched Zenith t-branch device may be useful in treating proximal endoleaks in bifurcated stent-grafts.
authors.affiliation: Vascular, Endovascular, & Renal Transplant Unit, Christchurch Hospital, Christchurch, New Zealand adib.khanafer@cdhb.health.nz.
authors.forename: Adib
authors.initials: A
authors.lastname: Khanafer
authors.affiliation: Department of Vascular Surgery, University of Otago, Christchurch, New Zealand.
authors.forename: Manar
authors.initials: M
authors.lastname: Khashram
authors.affiliation: Vascular, Endovascular, & Renal Transplant Unit, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Carmen-Maria
authors.initials: CM
authors.lastname: Ruiz
authors.affiliation: Interventional Radiology, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Dana
authors.initials: D
authors.lastname: Mann
authors.affiliation: Interventional Radiology, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Laing
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*; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: abdominal aortic aneurysm; bifurcated stent-graft; endovascular aneurysm repair; juxtarenal aneurysm; multibranched stent-graft; sac enlargement; t-branch device; type Ia endoleak