Key result
Custom semi-inner branch endograft relining excludes complex endoleak while maintaining branch patency at 6 months.
Why the study?
Late failure of early-generation AFX endografts remains a challenge, sometimes presenting as combined type Ia/IIIa endoleak many years after EVAR.
Case Report (n=1)
No
Semi-inner branch relining is a viable, customized endovascular salvage option for high-risk patients presenting with late failure of early-generation unibody aortic endografts.
May support customized relining for late AFX endoleaks in select high-risk patients; leaves open durability and generalizability pending larger studies.
Late failure of early-generation AFX endografts remains a relevant challenge, sometimes presenting as combined type Ia/IIIa endoleak many years after apparently successful EVAR. We report an 85-year-old man who developed rapid sac enlargement 13 years after AFX-Strata implantation because of modular disconnection and proximal cuff migration. He was treated with relining using a custom-made semi-inner branch endograft, with adjunctive proximal thoracic extension to seal a residual endoleak. Completion angiography and follow-up CTA confirmed complete exclusion and branch patency, with uneventful recovery. This case highlights the need for lifelong surveillance after AFX implantation and supports semi-inner branch relining for high-risk patients.
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Gagliardo et al. (2026) conducted a case report in Late combined type Ia/IIIa endoleak after EVAR (n=1). Custom-made semi-inner branch endograft relining was evaluated on Complete aneurysm exclusion and branch patency on CTA. Relining with a custom-made semi-inner branch endograft successfully excluded the combined type Ia/IIIa endoleak while maintaining visceral patency at 6 months.
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