Rescue of a failing endovascular infrarenal aortic repair using an off-the-shelf branched endograft.

Background: Proximal aortic dilation following open and endovascular aortic repair (EVAR) is a well-known phenomenon. If severe enough, it may lead to late onset of type Ia endoleak that jeopardizes the proximal seal. Methods: We report the case of a patient previously treated by EVAR for an infrarenal aneurysm who developed a type Ia endoleak after proximal aortic dilation. His aneurysms enlarged to 10 cm mandating a rapid repair without the delay for a custom-made device. Results: We successfully used the off-the-shelf thoracic t-Branch graft (Cook, Bloomington, IN) with its 4 branches to treat the dilated aorta and seal the endoleak. Conclusion: The off-the-shelf t-Branch is a useful option in patient with previous EVAR presenting with proximal aortic dilation and endoleak who cannot wait for a custom-made device.