Total Laparoscopic Inferior Mesenteric Artery Clipping for Persistent Type II Endoleak Following EVAR: A Case Report and Review of Surgical Strategy.

BackgroundType II endoleak is the most common complication following endovascular aneurysm repair (EVAR), typically due to retrograde flow from collateral arteries, most notably the inferior mesenteric artery (IMA). Although usually low-pressure, persistent leaks associated with sac expansion warrant intervention.Case PresentationWe describe an 87-year-old male presenting with progressive aneurysm sac enlargement due to a persistent Type II endoleak post-EVAR. Initial management with intra-sac thrombin injection. Subsequently, a total laparoscopic IMA clipping was performed with intraoperative ultrasound verification of immediate endoleak cessation. Early postoperative duplex demonstrated reduction in endoleak volume.ConclusionTotal laparoscopic IMA clipping is a feasible minimally invasive option for refractory type II endoleak. Intra-operative ultrasound can provide real-time physiological confirmation of flow cessation. Long-term cross-sectional follow-up imaging was unavailable.