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The diagnostic and treatment challenge of type IIIb endoleaks

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1 The diagnostic and treatment challenge of type IIIb endoleaks
Rodolfo Pini, MD, Gianluca Faggioli, MD, Chiara Mascoli, MD, Antonio Freyrie, MD, Mauro Gargiulo, MD, Andrea Stella, MD  Journal of Vascular Surgery Cases  Volume 1, Issue 4, Pages (December 2015) DOI: /j.jvsc Copyright © 2015 The Authors Terms and Conditions

2 Fig 1 Patient 1 (A and B) and patient 3 (C and D). A, Preoperative digital subtraction angiography (DSA) of a type IIIb endoleak from both iliac limbs (arrows). B, Postoperative computed tomography angiography (CTA) reconstruction after treatment with two iliac limbs. C, Preoperative DSA of a type IIIb endoleak from the main body (arrow). D, Postoperative CTA reconstruction after treatment with a proximal cuff. Journal of Vascular Surgery Cases 2015 1, DOI: ( /j.jvsc ) Copyright © 2015 The Authors Terms and Conditions

3 Fig 2 Patient 5. Preoperative computed tomography (A) and volume rendering reconstruction of the endoleak (B, dotted line) with the identification of type II endoleak. The incomplete sealing of the right iliac limb led to an incorrect diagnosis of type Ib endoleak (C). D-F, Intraoperative angiography with exclusion of the type Ib endoleak from the right iliac limb (D), angiography of the “nidus” through cross-limb catheterization (E), and identification of the type IIIb endoleak (F, arrow). G and H, Intraoperative angiography of trans-limb sac embolization (G) and deployment of aortouni-iliac endoprosthesis with the exclusion of the type IIIb endoleak. I, Postoperative volume rendering reconstruction of the aortouni-iliac endoprosthesis and femoral-femoral crossover showing the resolution of the endoleaks. Journal of Vascular Surgery Cases 2015 1, DOI: ( /j.jvsc ) Copyright © 2015 The Authors Terms and Conditions

4 Fig 3 Patient 6. A, Preoperative computed tomography angiography (CTA) with possible type II endoleak. B, Intraoperative identification of an endograft tear (arrow). Journal of Vascular Surgery Cases 2015 1, DOI: ( /j.jvsc ) Copyright © 2015 The Authors Terms and Conditions

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