Successful treatment of endotension and aneurysm sac enlargement with endovascular stent graft reinforcement

Panagiotis Kougias, Peter H. Lin, Alan Dardik, W. Anthony Lee, Hosam Farouk El Sayed, Wei Zhou

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Abdominal aortic aneurysm (AAA) enlarges after successful endovascular repair because of endoleak, which is persistent blood flow within the aneurysm sac. In the absence of detectable endoleak, AAA may still expand, in part because of endotension, which is persistent pressurization within the excluded aneurysm. We report three patients who underwent successful endovascular AAA repair using the Excluder device (W. L. Gore & Associates, Flagstaff, Ariz). Although their postoperative surveillance showed an initial aneurysm regression, delayed aneurysm enlargement developed in all three, apparently due to endotension. Endovascular treatment was performed in which endograft reinforcement with a combination of aortic cuff and iliac endograft extenders were inserted in the previously implanted stent grafts. The endograft reinforcement procedure successfully resulted in aneurysm sac regression in all three patients. Our study underscores the significance of increased graft permeability as a mechanism of endotension and delayed aneurysm enlargement after successful endovascular AAA repair. In addition, our cases illustrate the feasibility and efficacy of an endovascular treatment strategy when endotension and aneurysm sac enlargement develops after endovascular AAA repair.

Original languageEnglish (US)
Pages (from-to)124-127
Number of pages4
JournalJournal of Vascular Surgery
Issue number1
StatePublished - Jul 2007

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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