The "fenestrated inside fenestrated" stent graft solution for therapy-resistant type Ia endoleak after fenestrated endovascular aortic aneurysm repair.

Endoleaks combined with increasing sac size following endovascular aneurysm repair require reintervention to prevent secondary aneurysm rupture. For standard infrarenal stent grafts, there are multiple treatment strategies available. However, in the presence of a fenestrated or branched stent graft, options are limited. We describe a novel challenging approach to treat a persistent type Ia endoleak by placing a second fenestrated stent graft into the pre-existing one, thus, realigning the graft and extending the proximal sealing zone.