Technique of partial open surgical stent graft explantation with preservation of fenestrated stent graft component to treat recalcitrant type II endoleak.

Fenestrated and branched stent grafts have been used with increasing frequency for endovascular repair of complex aortic aneurysms. Endoleaks are frequently encountered after endovascular aortic aneurysm repair, with treatment indicated when associated with an enlarging aneurysm sac. When endovascular treatment fails, complex open surgical explantation will become necessary. We have reported the technique of partial graft explantation in a patient with a recalcitrant type II endoleak. Both the proximal fenestrated segment and the distal iliac limbs were preserved, and aortic control was obtained by clamping the infrarenal stent graft. This method allowed for more distal aortic cross-clamping and negated the need for visceral branch reimplantation.