Aortic neck banding with endograft preservation for refractory type IA endoleak: The role of intraoperative duplex ultrasound

A case of late type IA endoleak is reported. The endoleak occurred approximately 1 year after successful treatment of a type IB endoleak with iliac branch device implantation in a patient who had undergone endovascular aneurysm repair 10 years earlier for an abdominal aortic aneurysm with severe neck angulation. The patient underwent secondary endovascular revision, which proved ineffective, with persistence of the endoleak and progressive aneurysm sac enlargement. A minimally invasive open surgical approach with endograft preservation, consisting of external proximal aortic neck banding, was therefore undertaken. Complete resolution of the endoleak was achieved and confirmed intraoperatively by duplex ultrasound. This case highlights the role of aortic neck banding as an effective salvage strategy for type IA endoleak refractory to endovascular treatment and the potential role of duplex ultrasound as a diagnostic gold standard in the intra- and postoperative periods.