Postoperative endoleak after EVAR and effective endovascular reintervention. The case of the 64-year old male with abdominal aortic aneurysm with concomitant common iliac artery aneurysm

Endovascular aneurysm repair (EVAR) is a widely accepted alternative for open surgical repair (OSR) in the treatment of an abdominal aortic aneurysm (AAA). Metaanalyses of randomized controlled trials revealed significantly lower short-term mortality after EVAR procedure than OSR. From a technical point of view, proper sizing and selection of the stent-graft is very important. Most instructions for use (IFUs) of the current endografts recommend 10-20% oversizing concerning the preoperative aortic diameter. It can prevent endoleaks or subsequent complications such as displacement of the leg to the abdominal aneurysmal sac. In this paper, we present a case of a 64-year old male with a history of abdominal aortic aneurysm with concomitant common iliac artery (CIA) aneurysm. The patient underwent endovascular implantation of bifurcated stent-graft with extension to the right common iliac artery. He was admitted to the Department of Vascular Surgery due to increasing pain in the right-lower abdomen. The analysis of the imaging examination and the symptoms of an increasing lower limb ischaemia caused by deformation of the stent-graft allowed to decide for an endovascular intervention involving the implantation of the iliac side branch device (IBD). Postoperative angiography confirmed the correct location of the IBD with proper blood flow. After five days the patient was discharged home.