Endoleak type IIIb - after repair of saccular thoracic aortic aneurysm

Case contributed by Bruno Di Muzio


Thoracic aortic aneurysm with endovascular stenting performed.

Patient Data

Gender: Male

Endograft metallic material delineating aortic arch and a rounded mass that bulges the left mediastinal contour and presents with linear parietal calcifications.

CT angiography demonstrates contrast breaching the margins of the aortic stent graft into the neck of the saccular aneurysm, the lumen of which is largely thrombosed.

Case Discussion

CT angiography is routinely undertaken in patients with stent grafts to assess graft position, patency, and to look for complications such as an endoleak. In this case, contrast is seen leaking into the aneurysm neck consistent with an endoleak.

As the leak is away from the graft ends and no collateral vessels are seen filling the aneurysm, these findings suggest endograft fracture or a defect in its middle portion in keeping with a type 3b endoleak. Although not definitively demonstrated, there is an area suspicious for a defect with the aortic graft in the inferior anterior aspect.

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