Successful open surgical treatment for persistent type Ⅱ endoleak following thoracic endovascular aortic repair: A case report

Abstract

Abstract Background: The occurrence of type II endoleaks after repair of endovascular aortic aneurysm has gradually gained increasing attention. We present a case of a patient with an expanding aneurysm after thoracic endovascular aortic repair (TEVAR) for a type II endoleak, in which successful direct ligation of the intercostal artery was performed using a sacotomy with no cardiopulmonary bypass (CPB) or graft replacement. Case presentation: A 62-year-old male patient, previously treated with TEVAR for a descending thoracic aortic aneurysm, presented with ongoing chest discomfort. Based on the diagnosis of a growing aneurysm and type II endoleak, a longitudinal opening of the thoracic aortic aneurysm sac was performed following left thoracotomy. The patient was scheduled for CPB and aortic cross-clamping, as a precautions against the possibility of a type I endoleak. Visual confirmation identified the T5 level intercostal artery as the source of the endoleak, and after confirming the absence of a type I endoleak, multiple ligations were applied to the intercostal artery. Follow-up computed tomography confirmed the absence of endoleaks or sac growth. Conclusion: After performing TEVAR for a thoracic aortic aneurysm, open suture ligation was used to treat type II endoleaks without having to resort to CPB, resulting in successful outcomes.