Total realignment of multibranch stent graft using redo branch-in-branch endovascular repair for occult endoleak with rapid aneurysm sac expansion
oleh: Aleem K. Mirza, MD, Emanuel R. Tenorio, MD, PhD, Thanila A. Macedo, MD, Jussi M. Kärkkäinen, MD, PhD, Swati Chaparala, MD, Gustavo S. Oderich, MD
| Format: | Article |
|---|---|
| Diterbitkan: | Elsevier 2020-09-01 |
Deskripsi
Occult endoleaks can pose a diagnostic and treatment challenge. These endoleaks are not effectively identified by multiphase computed tomography angiography, magnetic resonance angiography, or contrast-enhanced ultrasound. Possible causes are small fabric tears and slow-flow, dynamic, or positional endoleaks. We describe a patient with rapid aneurysm sac expansion and disseminated intravascular coagulopathy 46 months after four-vessel branched physician-modified endograft repair of a ruptured extent III thoracoabdominal aneurysm. Imaging failed to demonstrate an endoleak but identified fresh blood products within the sac. The patient underwent total realignment using branch-in-branch repair with a physician-modified endograft. Repeated imaging 25 days postoperatively revealed decrease in aneurysm diameter by 10 mm.