Endovascular Conversion after Endovascular Aneurysm Sealing (EVAS): Hybrid Treatment of a Case of Late Type IA Endoleak - Abstract
Endovascular aneurysm sealing (EVAS) with the Nellix device has been a different solution for Abdominal Aortic Aneurysm (AAA) repair. The incidence of type 1a endoleaks after Nellix EVAS was researched in short-term and long-term follow-up. To avoid eventual sac rupture, early diagnosis and classification are important. We then describe a successful endovascular hybrid treatment of a type 1a endoleak, five years after Nellix EVAS implantation.An 83-year-old patient, who submitted to endovascular aneurysm sealing (EVAS) on 2018, presented a type IA endoleak 5 years later, with enlargement of the aneurysmal sac (maximum diameter 82mm). We envisaged a hybrid endovascular correction consisting of implantation of a custom-made 4-branchdevice and the placement of aortouniliac endoprosthesis, which was then completed by packing a right>left femoral femoral crossover bypass in PTFE 8mm and left iliac axis occlusion with Amplatzer Vascular Plug II. He underwent angiography with coil embolization of the channels, obtaining a positive result. At 1 month, he is endoleak free, with a stable aneurysmal diameter.Key points• A Case of Late Type IA Endoleak After Endovascular Aneurysm Sealing• We report a successful endovascular hybrid treatment of a type 1a endoleak• At 1 month, patient is free from endoleak, with a stable aneurysmal diameter