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 endoprosthesis (EVAR) 10 years ago. At the last follow-up image control (4 months ago), a type Ic endoleak has been reported. The patient was awaiting for treatment in our hospital.

Patient Data

Age: 80 years
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 hematoma appears to arise from this segment of the abdominal aorta.

3D Volume Rendering showing type Ic endoleak.

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.

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