Abstract：
A 66-year-old man had an enlarging aortic aneurysm sac after an endovascular aortic replacement procedure that had been performed at another institution 4 years previously; it was without any endoleak but was complicated by the occlusion of the left limb, requiring cross-femoral bypass. Current computed tomography revealed dilatation of the proximal neck and the right common iliac artery. A type Ib endoleak was found from the distal end of the right limb of the endograft, possibly secondary to the dilatation of the artery around it; it then pressurized and caused the dilatation of the juxtarenal aorta around the proximal landing zone and induced a concomitant type Ia endoleak. The patient was operated on owing to the risk of rupture. Pelvic ischemia was a concern during decision-making. The patient underwent removal of the endograft and replacement of a bifurcated aortoiliac and femoral graft with good outcome. Midline laparotomy and a supraceliac clamping approach enable the removal of endografts with suprarenal fixation and revascularization of internal iliac arteries. Open repair offers a definitive solution for complicated endoleaks when endovascular options could be risky and ineffective.
摘要：
一名66岁的男子在4年前在另一个机构进行了血管内主动脉置换手术后，主动脉瘤囊扩大；它没有任何内漏，但由于左肢闭塞而变得复杂，需要交叉股动脉旁路术.目前的计算机断层扫描显示近端颈部和右髂总动脉扩张。从内移植物右肢的远端发现了Ib型内漏，可能是继发于其周围动脉扩张；然后加压并引起近端着陆区附近主动脉扩张，并引起伴随的Ia型内漏。由于有破裂的风险，患者接受了手术。盆腔缺血是决策过程中的一个问题。患者接受了腔内移植物的切除和分叉的主动脉和股骨移植物的置换，效果良好。中线剖腹手术和腹腔夹闭方法可通过肾上固定和血管内动脉重建术切除内移植物。当血管内选择可能有风险且无效时，开放式修复为复杂的内漏提供了明确的解决方案。
