Thoracoabdominal multibranch endograft repair of type Ia endoleak after laser in situ fenestration and chimney endovascular repair for pararenal aortic aneurysm

Failure after endovascular aneurysm repair (EVAR) often presents unique challenges in terms of definitive repair and is often associated with more extensive coverage of the descending thoracic aorta combined with a solution for the visceral aortic branches. Failure after a fenestrated or branched EVAR presents an even greater technical challenge and often requires conversion to open explantation and thoracoabdominal repair. We present a case of a 64-year-old woman who failed EVAR owing to aortic neck dilatation leading to symptomatic type Ia endoleak and underwent laser in situ fenestrated endograft repair with bilateral renal chimney stenting. Owing to aneurysm sac expansion and continued type Ia endoleak, she consented to urgent thoracoabdominal multibranched endoprosthesis with left iliac branched endoprosthesis for definitive repair. The patient consented to publication of this case report.