# Successful open surgical treatment for persistent type II endoleak following thoracic endovascular aortic repair: a case report

## TL;DR

A patient with a persistent type II endoleak after aortic repair was successfully treated with open surgery without using heart-lung bypass.

## Contribution

A novel open surgical technique for treating type II endoleaks without cardiopulmonary bypass is presented.

## Key findings

- Direct ligation of the intercostal artery successfully resolved the type II endoleak.
- No cardiopulmonary bypass or graft replacement was needed during the procedure.
- Follow-up imaging confirmed no endoleaks or aneurysm sac growth.

## Abstract

The occurrence of type II endoleaks after endovascular repair of aortic aneurysm has gradually gained increasing attention. We present a case of a patient with an expanding aneurysm after thoracic endovascular aortic repair (TEVAR) for a type II endoleak, in which successful direct ligations of the intercostal artery were performed using a sac incision without cardiopulmonary bypass (CPB) or graft replacement.

A 62-year-old male patient, previously treated with TEVAR for a descending thoracic aortic aneurysm, presented with ongoing chest discomfort. Based on the diagnosis of a growing aneurysm and type II endoleak, the patient was prepared for CPB and aortic cross-clamping, as a precautions against the possibility of a type I endoleak. A longitudinal opening of the thoracic aortic aneurysm sac was performed following left thoracotomy. Visual confirmation identified the T5 level intercostal artery as the source of the endoleak, and after confirming the absence of a type I endoleak, multiple ligations were applied to the intercostal artery. Follow-up computed tomography confirmed the absence of endoleaks or sac growth.

In a case involving TEVAR for a thoracic aortic aneurysm, open suture ligations were used to treat type II endoleaks without having to resort to CPB, resulting in successful outcomes.