Urgent Relining of a Fenestrated Stent-Graft for Symptomatic Type V TAAA due to Late Type IIIB and IIIC Endoleaks in a Patient With Marfan Syndrome Case Report and Literature Review.
Simone Cuozzo, Jihad Jabbour, Carola D'Amico et al.
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Case in brief
A 55-year-old woman with Marfan syndrome and multiple prior cardiovascular operations presented with chest pain from a large type V thoracoabdominal aortic aneurysm after fenestrated endovascular repair. CT angiography showed type IIIB/IIIC endoleaks associated with disconnection and fracture of bridging stents and fabric tears involving renal and visceral artery stents. Urgent endovascular relining with balloon-expandable stent-grafts increased stent protrusion and oversizing. Her symptoms resolved, with no spinal cord ischemia; follow-up imaging showed aneurysm exclusion and continued patency of the target vessels.
What made this case unusual
The late type IIIB/IIIC endoleaks arose in a Marfan patient after fenestrated repair and involved multiple bridging-stent failures, including disconnection, fracture, and fabric tears.
Diagnostic / clinical pearl
In a patient with Marfan syndrome and prior fenestrated repair, chest pain with aneurysm enlargement warrants assessment for type III endoleak; CT angiography can identify bridging-stent failure and fabric tears.
Why it matters
The report highlights the need for lifelong aortic surveillance in specialized centers after endovascular repair in connective tissue disorders, given uncertainty about long-term durability and endoleak incidence.