Late endoleak after endovascular repair of an abdominal aortic aneurysm with multiple proximal extender cuffs Yehuda G. Wolf, MD, Bradley B. Hill, MD,

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Late endoleak after endovascular repair of an abdominal aortic aneurysm with multiple proximal extender cuffs Yehuda G. Wolf, MD, Bradley B. Hill, MD, Thomas J. Fogarty, MD, Paul R. Cipriano, MD, Christopher K. Zarins, MD Journal of Vascular Surgery Volume 35, Issue 3, Pages 580-583 (March 2002) DOI: 10.1067/mva.2002.119950 Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 A, Abdominal radiogram after initial endovascular repair shows aortic stent graft with mild curvature. B, Corresponding schematic (Fig 2, B ) shows configuration of each individual stent graft module (marked with double-ended arrows ). Main bifurcation module was deployed below aneurysm neck (arrow no. 1). Three additional extender modules (arrows 2, 3, and 4) were placed in overlapping fashion to bridge gap to renal arteries. C, Abdominal radiogram obtained after onset of acute abdominal pain, 13 months after procedure, shows increased curvature of stent graft in region of proximal extender modules. D, Abdominal radiogram obtained after insertion of second bifurcated stent graft adjacent to renal arteries within multiple extender modules. Journal of Vascular Surgery 2002 35, 580-583DOI: (10.1067/mva.2002.119950) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Cross-sectional computed tomographic (CT) scan images obtained at several time points were all taken at same axial level. A, CT scan 1 month after endovascular repair shows thrombosed aneurysm sac around stent graft. Sac measures 68 mm in its maximal transverse diameter. B, Follow-up CT scan obtained routinely after 12 months shows thrombosed aneurysm sac, which has decreased in size. C, CT scan obtained emergently after onset of abdominal pain shows large endoleak and acute expansion of aneurysm. D, CT scan 2 months after repair of endoleak shows completely thrombosed aneurysm sac. Two layers of stent graft are evident. Journal of Vascular Surgery 2002 35, 580-583DOI: (10.1067/mva.2002.119950) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 A, Grayscale ultrasound scan obtained at time of endoleak shows misalignment of grafts. B, Color-flow duplex ultrasound scan shows endoleak originating at that site. C, Aortogram shows large endoleak arising at site disengagement between lowest extender cuff and main bifurcation module. Journal of Vascular Surgery 2002 35, 580-583DOI: (10.1067/mva.2002.119950) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions