Huistra Emiel W M, Tielliu Ignace F J, Kater G Matthijs, Bloemsma Gijs C, Zeebregts Clark J
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Endovasc Ther. 2025 Apr;32(2):357-362. doi: 10.1177/15266028231179426. Epub 2023 Jun 7.
To present a rare cause of type III endoleak via the left renal artery (LRA) fenestration following fenestrated endovascular aneurysm repair (FEVAR) and to describe a successful reintervention for treating this endoleak.
The patient presented with a type IIIc endoleak following FEVAR, due to inadvertent placement of the LRA bridging balloon expandable covered stent (BECS) via the superior mesenteric artery (SMA) fenestration, but deployed outside the SMA fenestration. The proximal part of the BECS was positioned outside of the main body. This caused a type IIIc endoleak via the open LRA fenestration. Reintervention was performed by relining the LRA with a new BECS. First, access to the lumen of the previously placed BECS was gained using a re-entry catheter, followed by placement of a new BECS via the LRA fenestration. Completion angiography, and computerized tomography angiography (CTA) at 3 months follow-up showed total obliteration of the endoleak and patency of the LRA.
Placement of a bridging stent via an incorrect fenestration during FEVAR is a rare cause of type III endoleak. In certain cases, successful treatment of such an endoleak could be achieved by perforation and relining of the misplaced BECS via the correct fenestration of the target vessel.Clinical ImpactTo our best knowledge, a type IIIc endoleak following fenestrated endovascular aneurysm repair, due to placement of a bridging covered stent through an incorrect fenestration and deployed short of the fenestration, has not been described before. Reintervention was performed with perforation of the previously placed covered stent and relining using a new bridging covered stent. The technique presented here was successful for treating the endoleak in this case and could help guide clinicians when dealing with this or similar complications.
介绍开窗腔内动脉瘤修复术（FEVAR）后经左肾动脉（LRA）开窗出现III型内漏的罕见原因，并描述成功治疗该内漏的再次干预方法。
该患者在FEVAR后出现IIIc型内漏，原因是LRA桥接球囊扩张式覆膜支架（BECS）经肠系膜上动脉（SMA）开窗意外置入，但部署在SMA开窗之外。BECS的近端位于主体之外。这导致经开放的LRA开窗出现IIIc型内漏。通过用新的BECS重新内衬LRA进行再次干预。首先，使用再入导管进入先前放置的BECS管腔，然后经LRA开窗放置新的BECS。完成血管造影，以及3个月随访时的计算机断层血管造影（CTA）显示内漏完全消失且LRA通畅。
FEVAR期间经错误开窗放置桥接支架是III型内漏的罕见原因。在某些情况下，通过经目标血管正确开窗对误置的BECS进行穿孔和重新内衬可成功治疗此类内漏。临床影响据我们所知，此前尚未描述过开窗腔内动脉瘤修复术后因通过错误开窗放置桥接覆膜支架且部署在开窗之外而导致的IIIc型内漏。通过对先前放置的覆膜支架进行穿孔并用新的桥接覆膜支架重新内衬进行再次干预。本文介绍的技术成功治疗了该病例的内漏，可帮助临床医生处理此类或类似并发症时提供指导。
