2017 Volume 26 Issue 5 Pages 241-245
Migration of the stent is one of the complications of endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA), potentially leading to aortic rupture. Most migrations occur at proximal side of the stent and there are few reports of distal leg migration. We present a case where we successfully treated delayed the type Ib endoleak caused by leg proximal migration after EVAR for AAA and CIAA. The patient was a 74-year-old man diagnosed with infra-renal AAA and bilateral CIAAs. We first performed coil embolization of the bilateral internal iliac artery, then performed EVAR next. We chose Excluder device and deployed graft legs to the bilateral external iliac arteries. No intraoperative endoleaks were detected. Thirteen months after EVAR, a pulsatile abdominal mass developed, which was confirmed with enhanced CT as a type Ib endoleak. The right leg proximal migration caused the endoleak, and there was no right CIAA expansion. Six additional months later, the leg migration and the endoleak had progressed, and thus we proceeded to perform re-operation. We deployed an additional leg device from the right femoral artery approach, and the endoleak disappeared. Four months after re-operation, endoleaks had not been detected with enhanced CT.
