Fenestrated endovascular repair (FEVAR) provides an effective solution for complex aortic aneurysms. However, physicians often encounter complications like Type IIIc endoleaks. Effective Type IIIc endoleak management is critical because these leaks involve flow between the fenestration and the bridging stent. While some endoleaks resolve on their own, persistent ones require secondary interventions to prevent aneurysmal sac expansion and potential rupture.

Innovation in Type IIIc Endoleak Management

Researchers recently described a percutaneous stent-and-plug rescue maneuver for refractory cases. The study followed five consecutive patients who failed prior angioplasty or re-stenting attempts. These endoleaks appeared at a mean of 2.47 months after the initial repair. Therefore, the surgical team developed a novel approach using a stent and a vascular plug to achieve a definitive seal in the fenestration-free space.

During the procedure, surgeons used bilateral femoral access under moderate sedation. They protected the target-vessel stent with a balloon while catheterizing the fenestration contralaterally. Subsequently, the team deployed a 5 × 16 mm iCast™ stent within the fenestration. They then positioned an Amplatzer vascular plug inside this new stent. Finally, the surgeons re-inflated the target-vessel balloon to crush the stent-plug complex, creating a mechanical seal.

Clinical Success and Safety Outcomes

The stent-and-plug technique achieved high technical success in the study cohort. Four out of five cases showed complete sealing immediately after the rescue maneuver. The remaining case required only one additional procedure to achieve a complete seal. Furthermore, the researchers observed no renal branch occlusion or dialysis-requiring renal injuries. Procedure-related mortality remained at zero, which highlights the safety of this percutaneous approach.

Follow-up data at a mean of 8.96 months showed no further aneurysm sac growth. This suggests that the maneuver provides a stable solution for patients who fail conventional secondary interventions. However, clinicians should maintain extended surveillance to confirm the long-term durability of the seal. This technique offers a feasible and safe option for managing persistent Type IIIc endoleaks when traditional methods fall short.

Frequently Asked Questions

What defines a Type IIIc endoleak in FEVAR?

A Type IIIc endoleak refers to blood flow occurring through the space between a graft fenestration and the bridging stent that connects to a target vessel.

When should clinicians consider the stent-and-plug technique?

Clinicians should consider this technique for persistent Type IIIc endoleaks that fail to respond to standard angioplasty or traditional re-stenting attempts and are associated with potential sac expansion.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Refer to the latest local and national guidelines for clinical practice.

References

Alsarayreh M et al. A New Technique Using a Stent and a Plug for the Management of Persistent Type IIIc Endoleak Following Fenestrated Endovascular Aortic Repair (FEVAR). Vasc Endovascular Surg. 2026 Feb 19. doi: 10.1177/15385744261424745. PMID: 41711099.