Endoleak: type Ic and ruptured abdominal aortic aneurysm

Case contributed by Dr Gerard Carbo

Presentation

A 80 year old male patient presented with shock and abdominal pain at our emergency medical department. He had a history of abdominal aortic aneurysm treated with an endoprotesis (EVAR) 10 years ago. At the last follow-up image control (4 month ago), a type Ic endoleak has been reported. The patient was awaiting for treatment in our hospital.

Patient Data

Age: 80
Gender: Male

Type Ic endoleak arising from the right iliac limb of the aortic stent-graft associated to an extravasation of contrast medium arising from the right side wall of the aneurismal sac. Note the presence of perianeurysmal hematoma. A large left sided retroperitoneal haematoma appears to arise from this segment of the abdominal aorta.

CT

3D Volume Rendering

3D Volume Rendering showing type Ic endoleak.

Diagram

Endoleaks classification

Endoleak types or classification

Case Discussion

Endoleak: Persistent perfusion of excluded aneurysm sac after endograft placement.

  • Type I: perfusion of aneurysm sac via incomplete/ineffective seal at endograft attachment site.
     
    • Type IA: originates at proximal attachment site
      • e.g. infrarenal attachment of upper margin of bifurcated abdominal aortic endograft body
         
    • Type IB: originates at distal attachment site
      • e.g. common iliac artery attachment of limb of bifurcated abdominal aortic endograft

Type I endoleak should always be repaired when identified: If noted during EVAR or thoracic endovascular aortic repair (TEVAR), should be treated at that time. Should also treat any delayed type I endoleak seen on follow up imaging.

PlayAdd to Share

Case information

rID: 32126
Case created: 15th Nov 2014
Last edited: 16th Aug 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.