LAUSR

Despite the overall favourable early outcomes of endovascular aneurysm repair (EVAR), the need to identify and prevent complications unique to this management modality, such as endoleak, graft migration and structural graft failure, remains a challenge. The ability to maintain lifelong surveillance after EVAR is a wellrecognized issue and remains a necessary consideration in preoperative planning. With a 30–50% annual risk of rupture associated with abdominal aortic aneurysms (AAA) measuring >8.0 cm, prompt recognition and repair are paramount. We report the management of a giant non-ruptured AAA measuring 16.5 cm in an elderly male who was lost to follow-up after undergoing EVAR. A 67-year-old male underwent EVAR for an asymptomatic 89 89 mm AAA using a Cook Zenith Endograft (TFFB-26-11). His background included asbestosis, hypertension and hypercholesterolaemia. He had no history of cardiovascular disease but had a strong family history with both father and brother deceased at young ages from cardiac disease. The aneurysm neck measured 19–20 mm, with a less than 60 angulation anterolaterally. The right common iliac artery (CIA) was ectatic measuring 23 mm. His anatomy was fitting within the manufacturer’s instructions-for-use. Open repair was explored with the patient; however, EVAR was performed based on the patient’s preference. He was followed up at 3-monthly intervals post-operatively with regression of sac size and no endoleak identifiable on duplex ultrasound (US). At 24-month surveillance, a type 2 endoleak (T2E) was noted with marginal increase in sac size measuring 83 85 mm (compared to 79 81 mm on previous surveillance US). He underwent selective angiography, identifying a T2E via the lumbar arteries. This was effectively treated with transarterial Onyx embolization, with surveillance angiography demonstrating