DÄ internationalArchive14/2025Material Fatigue With Endoleak After Endovascular Repair of an Abdominal Aortic Aneurysm

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Material Fatigue With Endoleak After Endovascular Repair of an Abdominal Aortic Aneurysm

Dtsch Arztebl Int 2025; 122: 398. DOI: 10.3238/arztebl.m2025.0058

Walensi, M; Hoffmann, J N; Nassenstein, K

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a) 3D reconstruction and b) coronal slice from a CT angiography scan of the aorta with complete avulsion of the non-covered proximal part of the EVAR endograft (1, 2) from the covered part (3), resulting in a type Ia endoleak (4), caudal dislocation of the endograft and late expansion of the aneurysmal sac with increased risk of secondary aortic rupture. In the coronal slice, the cranial edge of the vertebral body of the fifth lumbar vertebra (5), the right (6) as well as both left (7) limbs of the EVAR endograft are also visible.
Figure
a) 3D reconstruction and b) coronal slice from a CT angiography scan of the aorta with complete avulsion of the non-covered proximal part of the EVAR endograft (1, 2) from the covered part (3), resulting in a type Ia endoleak (4), caudal dislocation of the endograft and late expansion of the aneurysmal sac with increased risk of secondary aortic rupture. In the coronal slice, the cranial edge of the vertebral body of the fifth lumbar vertebra (5), the right (6) as well as both left (7) limbs of the EVAR endograft are also visible.
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Prosthetic endograft-specific complications can occur after endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA). The complete avulsion (currently reported 7× in total and 1x for this endograft model) of the non-covered proximal part (strut) of the EVAR endograft, designed for suprarenal fixation, is a very rare complication. The strut avulsion (Figure a) shown here was detected in a 69-year-old patient at a follow-up examination with contrast-enhanced ultrasound six years after the patient underwent initial EVAR for AAA of 52 mm. Computed tomography angiography showed a type Ia endoleak (blood leaking into the supposedly excluded aneurysmal sac) (Figure b) with rapid (5 mm/6–12 month) expansion of the aneurysmal sac (here + 8 mm/4 months). In view of the secondary risk of rupture, it was decided to perform conversion surgery with complete explantation of the EVAR endograft and aortic replacement using the Y-graft technique. After intensive care treatment for a postoperative stroke due to an acute thrombotic occlusion of the left vertebral artery as well as symptomatic coronary heart disease, the patient was discharged to a rehabilitation facility on postoperative day 25.

Dr. med. Mikolaj Walensi, M.A., Prof. Dr. med. Johannes N. Hoffmann, Klinik für Gefäßchirurgie und Phlebologie, CONTILIA Gruppe – Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, j.hoffmann@contilia.de

Prof. Dr. med. Kai Nassenstein, Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Elisabeth-Krankenhaus Essen

Conflicts of interest: The authors declare no conflict of interest.

Translated from the original German by Ralf Thoene, MD.

Cite this as: Walensi M, Nassenstein K, Hoffmann JN: Material fatigue with endoleak after endovascular repair of an abdominal aortic aneurysm. Dtsch Arztebl Int 2025; 122: 398. DOI: 10.3238/arztebl.m2025.0058

a) 3D reconstruction and b) coronal slice from a CT angiography scan of the aorta with complete avulsion of the non-covered proximal part of the EVAR endograft (1, 2) from the covered part (3), resulting in a type Ia endoleak (4), caudal dislocation of the endograft and late expansion of the aneurysmal sac with increased risk of secondary aortic rupture. In the coronal slice, the cranial edge of the vertebral body of the fifth lumbar vertebra (5), the right (6) as well as both left (7) limbs of the EVAR endograft are also visible.
Figure
a) 3D reconstruction and b) coronal slice from a CT angiography scan of the aorta with complete avulsion of the non-covered proximal part of the EVAR endograft (1, 2) from the covered part (3), resulting in a type Ia endoleak (4), caudal dislocation of the endograft and late expansion of the aneurysmal sac with increased risk of secondary aortic rupture. In the coronal slice, the cranial edge of the vertebral body of the fifth lumbar vertebra (5), the right (6) as well as both left (7) limbs of the EVAR endograft are also visible.
Enlarge All figures
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