case_images: PMC4927212_01
case_images: Preoperation CT showed a 90-mm RAAA communicating with 12-mm aorto-caval fistula.
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case_images: PMC4927212_01_10.1177_2050313X16646526-fig1.jpg
case_images: fig1-2050313X16646526
case_images: ACF which was 12 mm in diameter. Angulated aneurysm and tortuous aorto-iliac access were also shown (Figure 1).
case_images: The angiography during the procedure: (a) intraoperative angiography showed continuing type Ia endoleak and Ib endoleak at the left common iliac artery and leakage into the venal cava; (b) a TRI-LOBE balloon was expanding to seal the Excluder Cuff stent-graft to the aneurysm neck; (c) expanding at the junction and dilating overlapping zone between Excluder iliac leg and Zenith iliac leg.
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case_images: After standard EVAR, however, persistent type Ia endoleak and Ib endoleak at the left common iliac artery (CIA) were confirmed via intraoperative angiography (Figure 2(a)). Gore Excluder Cuff (W.L. Gore & Associate, Flagstaff, AZ, USA) (Figure 2(b)) and a combination of Gore Excluder iliac leg with Zenith iliac leg at the left CIA (Figure 2(c)).
case_images: CT angiography 12 months after EVAR procedure showing favourable remodelling of the aorta, no type II endoleak and no recurrence of the A-V, arterio-venous communication.
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case_images: Follow-up CTA at 12 months demonstrated complete resolution of ACF without type II endoleak (Figure 3).