Endovascular Rescue of Type III Endoleak From an Abandoned Fenestration After Fenestrated Endovascular Aneurysm Repair.

BACKGROUND

Type III endoleak after fenestrated endovascular aneurysm repair of an abdominal aortic aneurysm is uncommon and difficult to treat when direct sac catheterization is not feasible.

CASE SUMMARY: A 78-year-old man presented 1 year after fenestrated endovascular aneurysm repair with 4 fenestrations. During the initial procedure, a fenestration for a right accessory renal artery could not be bridged and was occluded with an embolization device, leaving an abandoned fenestration. Follow-up computed tomography angiography showed sac enlargement, perigraft contrast, and perianeurysmal high attenuation fluid, consistent with type III endoleak. Transgraft sac access was achieved with dual steerable sheaths and a puncture needle, followed by coil embolization and relining with a modified stent graft. Computed tomography angiography 2 weeks later showed marked reduction of the endoleak.

DISCUSSION: The abandoned fenestration was the likely source of late type III endoleak, and transgraft puncture enabled controlled access to an otherwise inaccessible cavity.

TAKE-HOME MESSAGE: Transgraft puncture, coil embolization, and stent graft relining may provide a feasible rescue strategy for selected cases.