Continued Sac Expansion in the Absence of a Demonstrable Endoleak is an Indication for Secondary Intervention

摘要: The application of endovascular aortic aneurysm repair (EVAR) has grown considerably since it was first performed in 1990, with specialist centres using the technique up to 50% cases elective abdominal (AAA) repair. There are now numerous reports indicating that this approach is safe and a high early success rate. long-term efficacy less certain, however. Particular interest been focused upon phenomenon endoleak, which complication unique EVAR. Endoleak defined by White as ‘‘persistent blood flow outside lumen endoluminal graft but within Fig. 1. CT scan 6 weeks post-endovascular AAA. MAD= sac or adjacent vascular segment’’. De71 mm. tection an endoleak on postoperative surveillance therefore strong indication for secondary intervention, widely believed absence demonstrable can be equated successful treatment. This report describes example bifurcated endograft (Stentor, Mintec, Bahamas). Folaneurysm continued expand after lowing deployment, proximal seen repair, despite endoleak. angiography on-table balloon dilatation there remained suspicion persistent leak, confirmed routine discharge spiral computed tomography (CT) (single-phase, contrastCase Report enhanced, 2.5-mm slices). patient managed conservatively hope leak would seal A 52-year-old male, anticoagulated warfarin spontaneously. Repeat operextensive cardiovascular disease (left ventricular ejecation revealed no evidence Maximum tion fraction 26%) underwent EVAR 68-mm abaneurysm diameter (MAD) measured at 71 mm dominal commercial modular (Fig. 1). Subsequent follow-up scans 3, 6, 12 18 months operation further incidence ∗ Please address all correspondence to: R. K. Fisher, Department significant change MAD Clinical Engineering, Duncan Building, Royal Liverpool University Hospital, Daulby Street, L69 3GA, U.K. (71–72 mm).