Presentation
Acute, severe abdominal pain. EVAS device inserted 3 years ago.
Patient Data
Routine surveillance imaging post endovascular aneurysm sealing system (EVAS) insertion demonstrates satisfactory positioning on the endovascular device. The proximal margins of the stents lie at the level of the right renal artery. There is a chimney graft extending from the left renal artery into the aorta. High attenuation polymer noted within the endobags.
Both limbs of the device have migrated distally since the time of insertion resulting in a type Ia endoleak which is seen outlining the anterior margins of the endobags.
There are concentric rings of high attenuation within the aneurysm sac, notable on the non-contrast images (dense rim sign) suggestive of acute hematoma and raising concern for impending rupture.
Case Discussion
Findings demonstrate a type Ia endoleak due to distal migration of the EVAS. The patient was not a candidate for an open repair and device removal and died shortly afterwards from a ruptured abdominal aortic aneurysm.
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