A Case of Delayed Graft Leg Proximal Migration 13 Months after Endovascular Repair for the Aneurysms of Abdominal Aorta and Bilateral Common Iliac Arteries

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  • Yamazoe Shinji
    Department of Radiology, Tokyo Dental College Ichikawa General Hospital
  • Harada Hirohisa
    Department of Vascular Surgery, Tokyo Dental College Ichikawa General Hospital
  • Shoji Takahiro
    Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine
  • Sekimoto Yasuhito
    Department of Vascular Surgery, Tokyo Dental College Ichikawa General Hospital
  • Mogami Takuji
    Department of Radiology, Tokyo Dental College Ichikawa General Hospital

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Other Title
  • ステントグラフト挿入13カ月後にステント脚の中枢側migrationをきたした腹部大動脈・総腸骨動脈瘤の1例

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<p>Migration of the stent is one of the complications of endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA), potentially leading to aortic rupture. Most migrations occur at proximal side of the stent and there are few reports of distal leg migration. We present a case where we successfully treated delayed the type Ib endoleak caused by leg proximal migration after EVAR for AAA and CIAA. The patient was a 74-year-old man diagnosed with infra-renal AAA and bilateral CIAAs. We first performed coil embolization of the bilateral internal iliac artery, then performed EVAR next. We chose Excluder device and deployed graft legs to the bilateral external iliac arteries. No intraoperative endoleaks were detected. Thirteen months after EVAR, a pulsatile abdominal mass developed, which was confirmed with enhanced CT as a type Ib endoleak. The right leg proximal migration caused the endoleak, and there was no right CIAA expansion. Six additional months later, the leg migration and the endoleak had progressed, and thus we proceeded to perform re-operation. We deployed an additional leg device from the right femoral artery approach, and the endoleak disappeared. Four months after re-operation, endoleaks had not been detected with enhanced CT.</p>

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