LAUSR

INTRODUCTION Type 3 endoleak (T3E) is usually treated by endovascular relining. The procedure can be technically complex in cases of endografts with kinking of innermost stents. We report a case of T3E in an AFX (Endologix, Irvine, CA, USA) endograft with sac enlargement, billowing and severe kinking of the main body stents, managed with a complete relining endovascular procedure. CASE REPORT A 69-year-old man with severe comorbidities and prior aorto-biiliac AFX endograft completed by an Endurant II cuff (Medtronic, Santa Rosa, CA, USA) for a 63mm asymptomatic infrarenal aneurysm, was admitted to our department for a T3E with 7 mm-sac enlargement. The computed tomography angiography (CTA) showed perfusion of the aneurysmal sac, AFX fabric disconnection from its stent (billowing) and severe stent kinking of the main body without a residual lumen. A digital subtraction angiography confirmed the T3E. A complete relining was performed by deploying a bifurcated Endurant II through the AFX stents. The 1-year CTA proved the resolution of the endoleak with a stable aneurysmal sac diameter. CONCLUSION In case of T3E with severe main body stent kinking and graft billowing, an endovascular procedure with a complete aorto-biiliac relining through inner stents may be considered.