The Case of the Leaking Endograft

89 y.o. male with history of AAA, 9 cm wide and 16 cm in length, presented to the ED with back pain ongoing for one day. The patient’s AAA had been previously stented in December 2016. Prior to transfer to our ED, the patient was evaluated by to his cardiothoracic surgeon, who performed a CT scan which demonstrated ruptured AAA. The patient was hemodynamically stable upon arrival to our ED, therefore bedside ultrasound was performed. It showed leakage around one of the endografts in the infrarenal portion of the abdominal aorta. The septated portions you see are the result of hematoma formation within the leak.

Patient was admitted to the vascular surgery team where he underwent extension of the right iliac limb with a Gore Excluder iliac limb with resolution of type IB endoleak on the same day as admission. He did well postoperatively and was discharged on postoperative day one.

Research has shown that bedside ultrasound has excellent specificity (91%) in detection of leaks following endovascular repair of AAA. When compared to CT scan, bedside ultrasound missed a number of smaller, clinically non-significant leaks, leading to poor specificity (63%).

Sandford, R. et al. (2006). Duplex Ultrasound Scanning is Reliable in the Detection of Endoleak Following Endovascular Aneurysm Repair. Journal of Vascular Surgery, 44(5), 1129-1130. doi:10.1016/j.jvs.2006.09.033

 

Sarah McDaniels, PGY-1

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