CHIMNEY-GRAFT TECHNIQUE TO TREAT A TYPE IA ENDOLEAK AFTER A PREVIOUS EVAR

A 73 year old man who underwent an elective EVAR procedure in 2014 for an infrarenal AAA presented two years later with a type IA endoleak. The CTA showed a distal migration of the proximal part of the stent graft resulting in a type IA endoleak. In order to treat this new diagnosed endoleak an endovascular repair using chimney technique (with a snorkel-stent graft in the renal artery-bilaterally) with proximal extension of sealing zone with an endovascular aortic cuff has been undergone with implantation of a stent graft in the right renal artery as a periscope and a chimney in the left renal artery. Subsequently, an Endurant II Aortic Cuff was implanted. The whole procedure was performed using CO2 instead of iodinated contrast medium. In the 5 month follow-up with abdominal ultrasonography no endoleak could be identified with stabilization of aneurysmal sac diameter. The use of chimney technique adds an additional tool to the armamentarium of endovascular surgeon to deal with the complex type IA endoleaks Keywords: Abdominal aneurysm , CO2 angiography , chimney-graft technique, type IA endoleak, periscope technique.