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Intraoperative Ultrasound for Correction of Type III Endoleak may be Superior to Angiography

Endovascular aneurysm repair (EVAR) has become the primary form of treatment for infrarenal abdominal aortic aneurysm (AAA). Although this modality has demonstrated superior results in terms of mortality and morbidity over the short term when compared with open surgical treatment, there continues to be problems related to long-term durability. The repair needs ongoing monitoring, and endoleaks can lead to failure of the treatment at any time in the course of follow-up. Most vascular surgeons prefer ultrasound as a means of surveillance to computed tomography angiogram (CTA). When an endoleak is seen especially when associated with sac expansion, diligent investigation of the source of the endoleak and correction of the same is warranted. Precise identification of the endoleak can be challenging despite the use of all available modalities. We present a case where real-time ultrasound examination on the operating table clearly identified the source of the endoleak when angiography failed to do so.