Case report: Type IIIa endoleak due to disconnection of AFX2 and the Endurant aortic extension cuff after endovascular aneurysm repair

TL;DR

A case report describes a rare complication after aortic aneurysm repair, where a device disconnection led to a dangerous leak, requiring urgent treatment.

Contribution

This case highlights the risk of Type IIIa endoleak due to disconnection between modular devices from different manufacturers.

Findings

A 87-year-old patient developed a Type IIIa endoleak after AFX2 and Endurant cuff use.

Endovascular reintervention successfully sealed the leak without complications.

Device disconnection may result from self-expanding movement and linear forces.

Abstract

Type IIIa endoleak (TIIIaEL) is a serious complication following endovascular aneurysm repair, requiring immediate reintervention. We describe a case of TIIIaEL with proximal component separation in a patient treated with an AFX2 endograft.

TIIIaEL and an enlarged aneurysm were observed in an 87-year-old man 30 months after endovascular repair of an abdominal aortic aneurysm using an Endurant aortic extension cuff and an AFX2. The initial aneurysm diameter was 58 mm. Following surgery, the patient was discharged without complications. Follow-up was conducted with computed tomography every 6 months. The aneurysm decreased by 1–2 mm at the 24-month postoperative visit but subsequently showed gradual disconnection of the junction, leading to a diagnosis of aneurysm enlargement. After TIIIaEL, the aneurysm diameter was 62 mm. Urgent reintervention was performed through endovascular treatment instead of open surgery. Two non-bare VELA Proximal Endografts (A34–34/C100V, Endologix, Irvine, CA, USA) and one Excluder aortic extender (PLA280300J, W. L. Gore & Associates Inc., Flagstaff, Arizona, USA) were inserted into the gap between the proximal cuff and main body. No endoleaks were observed. The aneurysm diameter decreased without complications. No recurrence was documented after 1 year. The patient is progressing without noticeable symptoms.

The AFX-aortic extension cuff junction may become disconnected due to self-expanding movement and linear forces, causing TIIIaEL. Devices from different manufacturers may have contributed to the occurrence of TIIIaEL.

Modular device overlaps should be as long as possible, and close postoperative monitoring is necessary when this device is used.

•Type IIIa endoleak (TIIIaEL) is a serious post-aneurysm repair complication.•An 87-year-old man had TIIIaEL with proximal component separation after AFX2 use.•Urgent endovascular reintervention was chosen over open surgery to seal the leak.•Using devices from different manufacturers may lead to TIIIaEL.•Sufficient device overlapping and close monitoring are vital to prevent TIIIaEL.

Type IIIa endoleak (TIIIaEL) is a serious post-aneurysm repair complication.

An 87-year-old man had TIIIaEL with proximal component separation after AFX2 use.

Urgent endovascular reintervention was chosen over open surgery to seal the leak.

Using devices from different manufacturers may lead to TIIIaEL.

Sufficient device overlapping and close monitoring are vital to prevent TIIIaEL.

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