Endoleak Visualized With Carbon Dioxide Angiography During Endovascular Aneurysm Repair Using the Endurant Stent-Graft

Abstract

Purpose

To make interventionists aware of the potential for type IV endoleak on completion carbon dioxide (CO₂) angiography during endovascular aneurysm repair (EVAR) using the Endurant stent-graft.

Case Report

A 74-year-old man with chronic kidney disease underwent EVAR with an Endurant stent-graft using CO₂ angiography to guide graft placement. Completion CO₂ angiography demonstrated immediate accumulation of CO₂ in the aneurysm sac suggestive of an endoleak, but confirmatory angiography with conventional iodinated contrast showed no evidence of an endoleak. We speculate that this is a type IV endoleak, and graft porosity may be responsible.

Conclusion

Interventionists should be alerted to the possibility of visualizing these endoleaks through Endurant stent-grafts under CO₂ angiography. Further work should be done to elucidate the exact mechanism of the endoleak.

Keywords

endovascular aneurysm repair stent-graft endoleak type IV endoleak

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