Academic Journal
Urgent Relining of a Fenestrated Stent-Graft for Symptomatic Type V TAAA due to Late Type IIIB and IIIC Endoleaks in a Patient With Marfan Syndrome Case Report and Literature Review.
| Τίτλος: | Urgent Relining of a Fenestrated Stent-Graft for Symptomatic Type V TAAA due to Late Type IIIB and IIIC Endoleaks in a Patient With Marfan Syndrome Case Report and Literature Review. |
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| Συγγραφείς: | Cuozzo S; Vascular Surgery Division, Department of Surgery 'Paride Stefanini'-Policlinico Umberto I, 'La Sapienza' University of Rome, Rome, Italy., Jabbour J; Vascular Surgery Division, Department of Surgery 'Paride Stefanini'-Policlinico Umberto I, 'La Sapienza' University of Rome, Rome, Italy., D'Amico C; Vascular Surgery Division, Department of Surgery 'Paride Stefanini'-Policlinico Umberto I, 'La Sapienza' University of Rome, Rome, Italy., Molinari A; Vascular Surgery Division, Department of Surgery 'Paride Stefanini'-Policlinico Umberto I, 'La Sapienza' University of Rome, Rome, Italy., De Cicco ML; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology -Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Brizzi V; Vascular Surgery Department, CHU de Bordeaux, Bordeaux, France., Sbarigia E; Vascular Surgery Division, Department of Surgery 'Paride Stefanini'-Policlinico Umberto I, 'La Sapienza' University of Rome, Rome, Italy. |
| Πηγή: | Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2026 Oct; Vol. 33 (5), pp. 2520-2528. Date of Electronic Publication: 2025 Jun 28. |
| Τύπος έκδοσης: | Journal Article; Case Reports; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Sage Publications Country of Publication: United States NLM ID: 100896915 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1545-1550 (Electronic) Linking ISSN: 15266028 NLM ISO Abbreviation: J Endovasc Ther Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2015- : Thousand Oaks, CA : Sage Publications Original Publication: Phoenix, AZ : The Society, c2000- |
| Ιατρικοί όροι (MeSH): | Endoleak*/surgery , Endoleak*/diagnostic imaging , Endoleak*/etiology , Endovascular Aneurysm Repair*/instrumentation , Endovascular Aneurysm Repair*/adverse effects , Marfan Syndrome*/complications , Marfan Syndrome*/diagnosis , Aortic Aneurysm, Thoracoabdominal*/surgery , Aortic Aneurysm, Thoracoabdominal*/diagnostic imaging , Aortic Aneurysm, Thoracoabdominal*/etiology , Blood Vessel Prosthesis Implantation*/instrumentation , Blood Vessel Prosthesis Implantation*/adverse effects , Endovascular Procedures*/instrumentation , Endovascular Procedures*/adverse effects , Stents* , Blood Vessel Prosthesis*, Aortography/methods ; Humans ; Female ; Middle Aged ; Prosthesis Design ; Treatment Outcome ; Reoperation ; Computed Tomography Angiography ; Time Factors |
| Περίληψη: | Objective: Although open repair remains the standard of care for managing connective tissue disorders (CTDs), endovascular repair has emerged as an alternative, especially in patients with prior aortic surgery, using a "graft-to-graft" approach. Notwithstanding, long-term interaction between bridging stent-grafts and arterial wall of target vessels (TVs) remains under-investigated. We present a rare case of late-onset type IIIB/IIIC endoleaks in a symptomatic type V thoracoabdominal aortic aneurysm (TAAA) following fenestrated endovascular aneurysm repair (FEVAR) in a patient with Marfan syndrome (MFS), and a literature review. Methods: A 55-year-old woman with MFS and a history of multiple cardiovascular surgeries, including previous FEVAR using a graft-to-graft approach, presented with chest pain secondary to a large type V TAAA. Computed tomography angiography revealed type IIIB/IIIC endoleaks due to stent disconnection, stent fracture, and fabric tears involving renal and visceral arteries' bridging stents. An urgent endovascular relining was performed with balloon-expandable stent-grafts, achieving enhanced stent protrusion and increased oversizing. The postoperative course was uneventful, with complete resolution of symptoms and no evidence of spinal cord ischemia. Follow-up imaging confirmed complete aneurysm exclusion and maintained patency of TVs. Additionally, a comprehensive literature review was conducted in accordance with PRISMA guidelines, using the search term "MFS," "type IIIB/IIIC endoleak," and "Fenestrated stent-graft" to investigate the rate of incident type III endoleak. Out of 43 identified reports, 8 studies met the inclusion criteria. Results: Although infrequent (4%-5.9%), type IIIB/IIIC endoleaks after FEVAR in MFS patients may be underreported. These endoleaks may result from under-investigated interactions between bridging stents and TVs, especially due to the inherent fragility of the aortic wall in CTDs. In redo cases, adjunctive strategies, such as increased stent protrusion and greater oversizing, may be necessary to prevent further disconnections. Conclusions: Endovascular therapy provides a viable option for managing MFS patients, particularly in challenging redo cases with prohibitive surgical risks. Lifelong aortic surveillance in specialized centers and extended and careful follow-up is essential to assess the risks and the true incidence of high-flow endoleaks, as well as the overall safety and durability of these interventions, especially given the progressive nature of CTDs.Clinical ImpactThis study demonstrated the feasibility, safety, and time- and cost-effectiveness of single-disc vascular plug embolization for directional branches during urgent or emergent branched endovascular aortic aneurysm repair using off-the-shelf devices, even without elongation with balloon-expandable stent-grafts. This approach is particularly relevant in urgent scenarios, where minimizing procedural time is critical for optimizing patient outcomes, as well as in resource-limited settings, where efficient allocation of healthcare resources is essential. |
| Competing Interests: | Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Contributed Indexing: | Keywords: Marfan syndrome; endovascular treatment; fenestrated stent-graft; type IIIB/IIIC endoleak; urgent relining |
| Entry Date(s): | Date Created: 20250628 Date Completed: 20260916 Latest Revision: 20260916 |
| Update Code: | 20260916 |
| DOI: | 10.1177/15266028251351139 |
| PMID: | 40580078 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1545-1550 |
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| DOI: | 10.1177/15266028251351139 |