Endoleak post AAA repair

Case contributed by A.Prof Frank Gaillard

Presentation

Enlarging abdominal aneurysm sac.

Patient Data

Age: 70 years
Gender: Male
CT

CT angiography

A descending thoracic aorta and abdominal aortic aneurysm is present, extending into the common iliacs (particularly on the left) without extension into the arch. 

Aortic stent graft is present from just dital to the left subclavian artery to the aortic bifurcation with further stents in:

  1. coeliac axis
  2. superior mesenteric artery
  3. from the distal abdominal aortic stent pointing posterolaterally into the right lumbar artery at L4
  4. bilateral renal arteries.

There is opacification of the false lumen just above the L4 stent level and it fills in continuity to the level of the T9 vertebrae.   There is also opacification of the T9 and T10 intercostal arteries bilaterally which appears in continuity with the false lumen opacification.  The false lumen opacification is also in continuity with the right L1 segmental artery and the right and left L2 segmental arteries and the right and possibly left L3 segmental arteries. 

It is not clear if the lower abdominal aorta (below the stent) fills via the bilateral L4 lumbar arteries or via the inferior end of the stent (i.e it is possible the the lower end of the graft is occluded or that there is retrograde filling of the false lumen from below the stent).

There is no evidence of leak through or above the stents.  

The moderate left and small right pleural effusion with associated atelectasis noted at the left base.  Left hemicolectomy and end-colostomy partially imaged. 

CONCLUSION

Persistent filling of the false lumen of the thoracoabdominal aneurysm with patency of multiple segmental (intercostal and lumbar) arteries and possible filling via the inferior end of the abdominal aortic stent.   

Case Discussion

Endoleaks can be a challenge to treat as access to the feeding vessels is often difficult. 

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Case information

rID: 14661
Case created: 20th Aug 2011
Last edited: 16th Aug 2016
System: Vascular
Inclusion in quiz mode: Included

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