Early and Late Endograft Limb Proximal Migration with Resulting Type 1b Endoleak following an EVAR for Ruptured AAA

Figures

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  Figure 1. Computed tomography angiogram of ruptured AAA at initial presentation to the emergency department. (a) Three-dimensional reconstruction of the aneurysm sac. (b) Corresponding cross-sectional demonstrating rupture of AAA with active extravasation of contrast into the retroperitoneum.

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  Figure 2. Intraoperative aortogram at the initial procedure showing the correct placement of the endograft and limbs bilaterally.

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  Figure 3. Computed tomography angiography performed on postoperative day 2 demonstrating the proximal migration of the right endograft limb (arrow).

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  Figure 4. Intraoperative angiogram on postoperative day 2 demonstrating the acute proximal migration in the right common iliac artery resulting from the large aneurysm sac and the postimplantation change of the aortic anatomy.

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  Figure 5. Follow-up at 12 months demonstrates a proximal migration of the left endograft limb (asterisk) on three-dimensional reconstruction of the CTA (a), leading to a type 1b endoleak as demonstrated in the aortogram (b).

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  Figure 6. Surveillance follow-up CTA at 18 months. Three-dimensional reconstruction demonstrates the correct placement of the bilateral iliac limbs at the seal zones without evidence of endoleaks.

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  Figure 7. Sagittal view of computed tomography performed at 1, 6, and 12 months of follow-up demonstrating the anterior displacement of the aortic endograft.