876 A Sweeping Success – Management of Type 1A Endoleak Using A Chimney Graft Technique

Endoleak is a recognised complication after Endovascular Abdominal Aortic Aneurysm Repair (EVAR). In the setting of a rapidly expanding aneurysm – time is of the essence. Perfusion of the renal arteries, superior mesenteric artery (SMA) and coeliac artery must be maintained. To facilitate this a customised fenestrated endograft may be used or a chimney endovascular aortic repair (CHEVAR). A 78-year-old female initially underwent EVAR in 2016 for a ruptured 6.9cm AAA. She made a good recovery at that time. She was enlisted in a surveillance programme. Her most recent duplex showed an aneurysmal sac of 10cm with associated type 1A endoleak. Given these findings waiting for a fenestrated graft posed an unacceptable delay. She underwent a CHEVAR with bilateral axillary and right femoral access. She had chimney stents deployed in the renal arteries and SMA with aortic cuff extension proximally. Her completion angiogram showed good proximal seal with patent stents. She was unexpectedly unstable post-operatively and had a CT scan which revealed a re-ruptured aneurysm. She was treated in ICU and recovered well. Repeat imaging showed good flow in all 4 grafts with no endoleak. This case demonstrates the challenges of managing endoleak post EVAR and the importance of robust surveillance and appropriate, timely treatment.