A Case of Type IIIb Endoleak After AFX2 Device Insertion Treated with a Relining Technique

Abstract

Diagnosing type IIIb endoleak (EL) following endovascular aortic repair is difficult via both contrast-enhanced computed tomography (eCT) and intraoperative angiography. Here, we report a case of type IIIb EL that was successfully treated using the relining technique (RT).The patient was a 68-year-old male who underwent urgent endovascular aortic repair using AFX2 for an impending rupture of an abdominal aortic aneurysm. Postoperative eCT demonstrated type Ib EL at the right leg. Leg extension with right internal iliac artery embolization was performed. Although the aneurysm shrunk after the repeat surgery, eCT taken 14 months after the first surgery revealed re-enlargement of the aneurysm, migration of AFX2, and accumulation of the contrast medium in two places (the proximal side of AFX2 and around the bifurcation). With the diagnosis of type Ia EL and suspicion of IIIb EL, a second repeat surgery was performed. After proximal cuff placement, type Ia EL disappeared. After confirming that the residual distal EL was a type IIIb, RT was performed using the ENDURANT IIs bifurcated main body and the EXCLUDER leg. Intraoperative completion aortography and postoperative eCT confirmed the disappearance of all ELs, and outpatient follow-up was continued. With AFX2, once a diagnosis of type IIIb EL is made, relining can be easily performed using various devices by paying attention to the endoskeleton.