Management of a large intraoperative type IIIb endoleak in a bifurcated endograft: A case report

Matthias Biebl, Albert G. Hakaim, W. Andrew Oldenburg, Josef Klocker, J. Mark McKinney, Ricardo Paz-Fumagalli

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


The purpose of this paper is to describe the intraoperative management of a type IIIb endoleak after deployment of a bifurcated endograft in a patient with narrow iliac access vessels. A 62-year-old man underwent elective endovascular repair (EVAR) of a 53 mm abdominal aortic aneurysm. After device deployment, a large IIIb endoleak, arising from the main body of the device, was visualized. Narrow iliac vessels precluded deployment of a second bifurcated graft, and the endoleak was successfully excluded with an aortomonoiliac device, followed by contracteral iliac occlusion and subsequent creation of a femorofemoral bypass. At 1-year follow-up, the aneurysm remains excluded and is decreasing in size. Type III endoleaks are a known complication of EVAR, requiring immediate treatment through their association with aneurysm enlargement and rupture. If an additional bifurcated graft cannot be used, aortomonoiliac conversion represents a feasible endovascular alternative treatment for type III endoleaks, other than conversion to open surgical repair. Therefore, aortomonoiliac converters with appropriate occluder devices should be readily available during deployment of bifurcated devices.

Original languageEnglish (US)
Pages (from-to)267-271
Number of pages5
JournalVascular and Endovascular Surgery
Issue number3
StatePublished - May 2005

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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