Type IIIb endoleak due to stent suture line fabric breakage in the Endurant stent graft: a case report

Satoshi Takahashi; Toshiya Nishibe; Masaki Kano; Shinobu Akiyama; Toru Iwahashi; Hitoshi Ogino

doi:10.1186/s40792-022-01415-8

Type IIIb endoleak due to stent suture line fabric breakage in the Endurant stent graft: a case report

Surg Case Rep. 2022 Apr 19;8(1):72. doi: 10.1186/s40792-022-01415-8.

Authors

Satoshi Takahashi¹, Toshiya Nishibe², Masaki Kano¹, Shinobu Akiyama¹, Toru Iwahashi¹, Hitoshi Ogino¹

Affiliations

¹ Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
² Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. toshiyanishibe@yahoo.co.jp.

Abstract

Background: Early type IIIb endoleak is a very rare complication of endovascular aneurysm repair (EVAR).

Case presentation: An 87-year-old man was diagnosed with infrarenal abdominal aortic aneurysm. The patient underwent EVAR using the Endurant stent graft. Postoperative color duplex ultrasound revealed a regular row of pulsatile blood flow from the main body and left leg. The blood flow appeared to be bleeding from the stent suture lines because of its regularity. Type IIIb endoleak was suspected due to stent suture line fabric breakage but was not treated surgically or endovascularly because of the patient's poor general health status. Six months later, contrast-enhanced CT demonstrated a deformation and enlargement of the aneurysm sac as well as an oozing of the contrast medium on the main body and left limb. Thereafter, he died of a subdural hematoma due to a fall. Autopsy showed no visible abnormal erosion or holes on the graft fabric, suggesting that suture line fabric breakage may have existed during the manufacturing process.

Conclusions: Although rare, type IIIb endoleaks can occur even in the perioperative period after EVAR. Early type IIIb endoleaks may not resolve spontaneously and should be treated promptly, if possible.

Keywords: Endoleak; Fabric breakage; Stent graft.