Successful laparoscopic repair of refractory type Ia endoleak after endovascular abdominal aortic aneurysm repair Adam Q. Howard, MD, FRCS, Sidhartha.

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Successful laparoscopic repair of refractory type Ia endoleak after endovascular abdominal aortic aneurysm repair Adam Q. Howard, MD, FRCS, Sidhartha Sinha, MA, MSc, MRCS, Anthony Edwards, MRCP, FRCR, Ijaz Ahmad, FRCS, Christopher M. Backhouse, MD, FRCS, Jonathan Davies, FRCS Journal of Vascular Surgery Volume 61, Issue 1, Pages 275-279 (January 2015) DOI: 10.1016/j.jvs.2014.08.065 Copyright © 2015 Terms and Conditions

Fig 1 A, Computed tomography (CT) angiogram demonstrates a left anterior type Ia endoleak (red arrow). B, A preoperative contrast-enhanced duplex ultrasound image demonstrates brisk filling of the anterior portion of the aneurysm sac with contrast (red arrow) indicating the type Ia endoleak. C, A coronal view CT angiogram demonstrates unfavorable right renal artery anatomy (red arrow). Journal of Vascular Surgery 2015 61, 275-279DOI: (10.1016/j.jvs.2014.08.065) Copyright © 2015 Terms and Conditions

Fig 2 Intraoperative photographs demonstrate (A) placement of a suture through the aortic neck (black arrow) and (B) application of the Ligaclip (Ethicon, Somerville, NJ) anchor (black arrow) to buttress the suture under tension (white arrow). Journal of Vascular Surgery 2015 61, 275-279DOI: (10.1016/j.jvs.2014.08.065) Copyright © 2015 Terms and Conditions

Fig 3 A, On-table completion angiogram demonstrates abolition of the endoleak. Note Onyx (ev3 Endovascular, Inc. Plymouth, Minn) material (red arrow) and 5-mm Ligaclip (Ethicon, Somerville, NJ) anchors (black arrows) are visible. B, Intraoperative contrast duplex ultrasound image confirms abolition of endoleak. C, Computed tomography (CT) angiogram at 8 weeks postoperatively demonstrates no on-going endoleak. Journal of Vascular Surgery 2015 61, 275-279DOI: (10.1016/j.jvs.2014.08.065) Copyright © 2015 Terms and Conditions