Complete Modular Disconnection between AFX2 and VELA Leading to a Type IIIa Endoleak Two Years after Endovascular Aneurysm Repair

The AFX endograft (Endologix, Irvine, CA, USA) is known to have a high incidence of late type III endoleaks. We report a 76-year-old male who developed a type IIIa endoleak due to complete modular separation 2 years after endovascular aneurysm repair with an AFX2 main body and a VELA extension. Open surgical graft replacement was performed, and the postoperative course was uneventful. This case demonstrates that in the presence of a large aneurysm diameter or significant neck angulation, even Instructions for Use-compliant and recommended overlap may be insufficient. It suggests the necessity of securing greater overlap and implementing stricter follow-up.