A nonstandard custom-made device to treat a type IA endoleak 6 years after Nellix implantation

The Nellix graft has been withdrawn from the market for the early graft failures associated with sac enlargement and rupture. To manage this complication, open conversion has been described as the main solution. However, we report the case of an 85-year-old female patient admitted with a type IA endoleak on a Nellix graft, with 70-mm aneurysmal sac, and treated with a custom-made device manufactured by Cook, to fit the peculiar graft conformation and patient's anatomy. In this case, accurate prosthesis design and surgical planning were essential to complete the procedure with no intraoperative complications.