Abstract
Abdominal aortic aneurysm repair by endovascular techniques have gained wide acceptance as a treatment option. A potential well-known complication of endovascular repair includes endoleaks. Specifically, type 2 endoleak, which is described as retrograde flow into the aneurysm sac through collateral vessels, usually from the inferior mesenteric artery and/or lumbar arteries, can occur in up to 10% to 20% of patients. We describe a combined laparoscopic and endovascular approach to treat inferior mesenteric artery and lumbar arteries. An 85-year-old male underwent an uncomplicated endovascular repair of a 51-mm infrarenal abdominal aortic aneurysm. Routine follow-up at 36 months postoperatively revealed the presence of a type 2 endoleak, and that aneurysm had increased in size. The endoleak was repaired by laparoscopic ligation, guided by simultaneous angiography, of the inferior mesenteric artery and lumbar arteries. The completion angiography confirmed absence of endoleak. A postoperative CT at 12 months after second surgery demonstrated occluded inferior mesenteric artery and lumbar arteries without endoleaks and sac enlargement. Angiography-guided laparoscopic approach for endoleaks due to inferior mesenteric artery and lumbar arteries was a less invasive and effective alternative for type 2 endoleaks.
