Identification and implications of transgraft microleaks after endovascular repair of aortic aneurysms

Color flow duplex scan of patient A. Doppler assessment of small jets of flow that could be easily misinterpreted as artifact or branch endoleaks.

Late phase of arteriogram of patient A showing contrast pooling in aneurysm sac.

No distinct source of endoleak is identified from graft with standard digital subtraction angiogram with power injector and pigtail catheter.

Operative photography of bleeding microleak from vascular prosthesis. Black curved arrow points to arterial stream.

Photograph of graft, after explantation with its accompanying trauma, and rinsing. Fabric material is separated from stent frame, and broken sutures (black straight arrows ) are visible. There is a striking difference of tissue incorporation in midgraft compared with end implanted in iliac artery on left side of picture.

CT scan showing endoleak (black arrow ) intimately associated with middle segment of right iliac limb.

Oblique magnified digital subtraction angiogram demonstrating microleak (black arrow ) from midgraft.

Duplex scan demonstrating microleak from right iliac limb (white arrow ).

Angiogram of patient C with distal balloon occlusion demonstrates unequivocal midgraft microleak (large straight arrow ) into aneurysm sac. Curved black arrow points to contralateral iliac limb radiopaque marker, which has migrated caudal to lower gate markers (black arrowheads ).

Operative photograph of pulsatile arterial bleeding from midsection of iliac limb.