Intra-operative diagnosis of an intermittent endoleak not evident on conventional imaging,

Abstract

We describe a patient who underwent open surgical conversion 2-years after Endovascular Aneurysm Repair (EVAR) due to aneurysm expansion in the absence of an endoleak on conventional CT imaging. Surgical repair revealed an intermittent type III endoleak which was not apparent in the neutral position but became evident during manipulation of the iliac limbs. Change of the relative position of the limbs resulted in the appearance and disappearance of a pulsatile arterial jet from the left side due to a tear of the fabric at a site of close approximation and friction between the limbs. This lesion was corrected with a prolene suture with a Teflon pledget and additional wrapping with a bovine pericardium patch in order to prevent any possible future friction between the limbs. The post-operative course was uneventful and complete exclusion of the remnant sac was observed 4 years after surgical repair. Intermittent endoleaks may be a rare cause of aneurysm expansion post-EVAR and an increased awareness of this condition is necessary in order to select appropriate diagnostic and therapeutic modalities to identify and treat these lesions.

Keywords

• Posture-related endoleak
• Positional endoleak
• Endotension
• Open surgical conversion